iii

Foreword 

The mission of the National Heart, Lung, and Blood Institute (NHLBI) is to provide leadership and support for 

research in cardiovascular, lung, and blood diseases; sleep disorders; women’s health; and blood resources. The 

ultimate goal is to improve the health and well-being of the American people. Although program priorities are 

determined primarily by research opportunities, other factors have an influence: the magnitude, distribution, 

and trends of cardiovascular, lung, and blood diseases in the United States, as well as the ability to improve the 

Nation’s health; congressional mandates; the health needs of the Nation, as perceived by Institute staff and outside 

advisory groups; and recommendations from the National Heart, Lung, and Blood Advisory Council have a significant impact on establishing research priorities.

Evaluation of the Institutes program balance and program impact is a continuous process that relies on 

assessments of morbidity and mortality in the United States from cardiovascular, lung, and blood diseases. 

Consideration is given to their distribution among the population; to their trends over time; and to related statistics 

on population risk factors, lifestyles, medical care, and economic impact.

This Chart Book, like its predecessors, provides information on the progress being made in the fight against cardiovascular, lung, and blood diseases. It serves as a resource for the Institute as it plans and prioritizes future 

activities.

I would like to express my appreciation to Mr. Thomas Thom of the NHLBI for his time and effort in developing 

the material presented in this Chart Book.

[Signed]

Elizabeth G. Nabel, M.D. 

Director

National Heart, Lung, and Blood Institute

v

Contents

Foreword.................................................................................................................................................................. iii

List of Charts.......................................................................................................................................................... vii

1. Introduction......................................................................................................................................................... 1

Sources of Data ................................................................................................................................................... 1

Quality of Data .................................................................................................................................................... 1

ICD Revisions ..................................................................................................................................................... 3

Data Presentation................................................................................................................................................. 3

2. Background Data ................................................................................................................................................ 5

Cardiovascular Diseases ..................................................................................................................................... 5

Lung Diseases...................................................................................................................................................... 5

Blood Diseases.................................................................................................................................................... 6

Population ........................................................................................................................................................... 6

3. Cardiovascular Diseases................................................................................................................................... 19

Coronary Heart Disease..................................................................................................................................... 19

Heart Failure...................................................................................................................................................... 19

Cardiomyopathy ................................................................................................................................................ 19

Atrial Fibrillation and Other Heart Diseases..................................................................................................... 19

Cerebrovascular Diseases (Stroke).................................................................................................................... 20

Hypertensive Disease ........................................................................................................................................ 20

Diseases of Arteries........................................................................................................................................... 20

Congenital Malformations of the Circulatory System ...................................................................................... 20

4. Lung Diseases.................................................................................................................................................... 64

Chronic Obstructive Pulmonary Disease .......................................................................................................... 64

Asthma............................................................................................................................................................... 64

5. Blood Diseases .................................................................................................................................................. 87

Appendixes.............................................................................................................................................................. 92

Appendix A. International Classification of Diseases: Codes for Selected Diagnostic Categories 

(6th, 7th, 8th, 9th, and 10th Revisions)......................................................................................................... 93

Appendix B. Estimated Comparability Ratios for Selected Causes of Death, U.S. ....................................... 94

Appendix C. Definition of Terms..................................................................................................................... 95

Appendix D. Abbreviations.............................................................................................................................. 97

Appendix E. References................................................................................................................................... 99

vii

List of Charts

2 Background Data

2–1 Total Population by Mean Age, Percent Age 65 and Older, Race/Ethnicity, and Sex, U.S., 2007................ 6

2–2 Total Projected Population by Mean Age, Percent Age 65 and Older, Race/Ethnicity, and

Sex, U.S., 2020................................................................................................................................................ 7

2–3 Average Remaining Lifetime Years by Age, Race, and Sex, U.S., 2006........................................................ 7

2–4 Age-Adjusted Death Rates for All Causes by Race and Sex, U.S., 1950–2006............................................. 8

2–5 Unadjusted Death Rates for Selected Causes, U.S., 1950–2006 .................................................................... 9

2–6 Number of Days of Inpatient Hospital Care by Major Diagnosis, U.S., 1990–2006 ................................... 10

2–7 Age-Adjusted Death Rates by Major Diagnosis, U.S., 1990–2006.............................................................. 10

2–8 Leading Causes of Death, U.S., 2006 ............................................................................................................11

2–9 Leading Causes of Death by Age and Rank, U.S., 2006................................................................................11

2–10 Leading Causes of Death, White Males, U.S., 2006..................................................................................... 12

2–11 Leading Causes of Death, White Females, U.S., 2006 ................................................................................. 12

2–12 Leading Causes of Death, Black Males, U.S., 2006 ..................................................................................... 12

2–13 Leading Causes of Death, Black Females, U.S., 2006.................................................................................. 13

2–14 Leading Causes of Death, Asian Males, U.S., 2006 ..................................................................................... 13

2–15 Leading Causes of Death, Asian Females, U.S., 2006.................................................................................. 13

2–16 Leading Causes of Death, Hispanic Males, U.S., 2006 ................................................................................ 14

2–17 Leading Causes of Death, Hispanic Females, U.S., 2006............................................................................. 14

2–18 Leading Causes of Death, American Indian Males, U.S., 2006.................................................................... 14

2–19 Leading Causes of Death, American Indian Females, U.S., 2006 ................................................................ 15

2–20 Prevalence of Leading Chronic Conditions Causing Limitation of Activity, U.S., 2007 ............................. 15

2–21 Age-Adjusted Percent of Population Currently Smoking by Race and Sex, Ages 18 and Older, 

U.S., 1965–2007............................................................................................................................................ 16

2–22 Age-Adjusted Percent of Population With High Serum Cholesterol by Race and Sex, Ages 20–74, 

U.S., 1976–1980 to 2003–2006 .................................................................................................................... 17

2–23 Age-Adjusted Percent of Population That Is Overweight by Race and Sex, Ages 20–74, U.S., 

1976–1980 to 2003–2006.............................................................................................................................. 17

2–24 Projected Economic Cost of Cardiovascular, Lung, and Blood Diseases, U.S., 2010 ................................. 18

2–25 Projected Direct Cost of Cardiovascular, Lung, and Blood Diseases, U.S., 2010........................................ 18

3. Cardiovascular Diseases 

3–1 Cardiovascular Disease Deaths, Percent by Subgroup, U.S., 2006 .............................................................. 21

3–2 Heart Disease Deaths, Percent by Subgroup, U.S., 2006.............................................................................. 21

3–3 Stroke Deaths, Percent by Subgroup, U.S., 2006 ......................................................................................... 21
viii

3–4 Number of Hospitalizations, Physician Office Visits, and Deaths for Cardiovascular

Diseases, U.S., 2006...................................................................................................................................... 22

3–5 Change in Age-Adjusted Death Rates, U.S., 1950–2006.............................................................................. 23

3–6 Age-Adjusted Death Rates and Percent Change for All Causes and Cardiovascular 

Diseases, U.S., 1968 and 2006...................................................................................................................... 24

3–7 Average Annual Percent Change in Age-Adjusted Death Rates for All Causes and 

Cardiovascular Diseases, U.S., 1968–2006 .................................................................................................. 24

3–8 Average Annual Percent Change in Age-Adjusted Death Rates for All Causes and 

Cardiovascular Diseases by Race and Sex, U.S., 1999–2006....................................................................... 24

3–9 Deaths and Age-Adjusted Death Rates for Cardiovascular Diseases, U.S., 1979–2006 .............................. 25

3–10 Percent of All Deaths Due to Cardiovascular Diseases by Age, U.S., 2006................................................. 25

3–11 Age-Adjusted Death Rates for Cardiovascular Diseases by State, U.S., 2003–2005................................... 26

3–12 Percent Decline in Age-Adjusted Death Rates for Cardiovascular Diseases by State, 

U.S., 1993–1995 to 2003–2005 .................................................................................................................... 27

3–13 Age-Adjusted Death Rates for Heart Disease by Race/Ethnicity and Sex, U.S., 2006 ................................ 28

3–14 Death Rates for Heart Disease in Males by Age and Race/Ethnicity, U.S., 2006 ........................................ 28

3–15 Death Rates for Heart Disease in Females by Age and Race/Ethnicity, U.S., 2006..................................... 28

3–16 Age-Adjusted Prevalence of Acute Myocardial Infarction by Race and Sex, Ages 25–74, 

U.S., 1971–1975 to 2003–2006 .................................................................................................................... 29

3–17 Prevalence of Acute Myocardial Infarction by Age and Sex, U.S., 1999–2006........................................... 29

3–18 Prevalence of Acute Myocardial Infarction by Age and Race, U.S., 1999–2006......................................... 29

3–19 Prevalence of Angina Pectoris by Age and Sex, U.S., 1999–2006............................................................... 30

3–20 Prevalence of Angina Pectoris by Age and Race, U.S., 1999–2006............................................................. 30

3–21 Hospitalization Rates for Acute Myocardial Infarction, Ages 45–64 and 65 and Older, 

U.S., 1965–2006............................................................................................................................................ 31

3–22 Hospital Case-Fatality Rates for Acute Myocardial Infarction, Ages Younger Than 65

and 65 and Older, U.S., 1970–2006.............................................................................................................. 32

3–23 Age-Adjusted Death Rates for Coronary Heart Disease, Actual and Expected, U.S.,

1950–2006..................................................................................................................................................... 33

3–24 Age-Adjusted Death Rates for Coronary Heart Disease by Race/Ethnicity and Sex,

U.S., 1999–2006............................................................................................................................................ 34

3–25 Age-Adjusted Death Rates for Coronary Heart Disease by Race and Sex, U.S., 1950–2006...................... 35

3–26 Deaths and Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1980–2006............................... 36

3–27 Average Annual Percent Change in Age-Adjusted Death Rates for Coronary Heart Disease

by Race and Sex, U.S., 1950–2006............................................................................................................... 37

3–28 Average Annual Percent Change in Death Rates for Coronary Heart Disease by Age, Race,

and Sex, U.S., 1999–2006............................................................................................................................. 37

3–29 Age-Adjusted Death Rates for Coronary Heart Disease by Race/Ethnicity and Sex, 

U.S., 2006...................................................................................................................................................... 38
ix

3–30 Death Rates for Coronary Heart Disease in Males by Age and Race/Ethnicity, 

U.S., 2006...................................................................................................................................................... 38

3–31 Death Rates for Coronary Heart Disease in Females by Age and Race/Ethnicity, 

U.S., 2006...................................................................................................................................................... 38

3–32 Age-Adjusted Death Rates for Coronary Heart Disease by State, U.S., 2003–2005.................................... 39

3–33 Age-Adjusted Death Rates for Coronary Heart Disease by Country and Sex, 

Ages 35–74, 2007 ......................................................................................................................................... 40

3–34 Change in Age-Adjusted Death Rates for Coronary Heart Disease in Males by Country,

Ages 35–74, 1999–2007 ................................................................................................................................. 40

3–35 Change in Age-Adjusted Death Rates for Coronary Heart Disease in Females by Country, 

Ages 35–74, 1999–2007 .............................................................................................................................. 41

3–36 Age-Adjusted Prevalence of Heart Failure by Race and Sex, Ages 25–74, U.S., 1971–1975 to 

2003–2006..................................................................................................................................................... 41

3–37 Hospitalization Rates for Congestive Heart Failure, Ages Younger Than 65 and 65 and Older, 

U.S., 1971–2006............................................................................................................................................ 42

3–38 Hospital Case-Fatality Rates for Congestive Heart Failure, Ages Younger Than 65 and 

65 and Older, U.S., 1982–2006..................................................................................................................... 43

3–39 Age-Adjusted Death Rates for Heart Failure as the Underlying Cause by Race and Sex, 

U.S., 1981–2006............................................................................................................................................ 44

3–40 Age-Adjusted Death Rates for Any Mention of Heart Failure by Race and Sex, U.S., 

1981–2006..................................................................................................................................................... 45

3–41 Age-Adjusted Death Rates for Heart Failure as the Underlying Cause of Death by 

Race/Ethnicity and Sex, U.S., 2006.............................................................................................................. 45

3–42 Age-Adjusted Death Rates for Any Mention of Heart Failure by Race/Ethnicity and 

Sex, U.S., 2006.............................................................................................................................................. 46

3–43 Death Rates for Heart Failure as the Underlying Cause by Age, Race, and Sex, U.S., 2006....................... 46

3–44 Death Rates for Any Mention of Heart Failure by Age, Race, and Sex, U.S., 2006 .................................... 46

3–45 Age-Adjusted Death Rates for Cardiomyopathy by Race and Sex, U.S., 2006 ........................................... 47

3–46 Death Rates for Cardiomyopathy by Age, Race, and Sex, U.S., 2006 ......................................................... 47

3–47 Hospitalizations for Atrial Fibrillation by Primary and Secondary Diagnosis, U.S., 

1982–2006..................................................................................................................................................... 48

3–48 Hospitalization Rates for Atrial Fibrillation by Age, U.S., 1982–2006........................................................ 49

3–49 Age-Adjusted Prevalence of Stroke by Race and Sex, Ages 25–74, U.S., 1971–1975 to

2003–2006..................................................................................................................................................... 50

3–50 Prevalence of Stroke by Age and Sex, U.S., 1999–2006.............................................................................. 50

3–51 Prevalence of Stroke by Age and Race, U.S., 1999–2006............................................................................ 50

3–52 Hospitalization Rates for Stroke, Ages 45–64 and 65 and Over, U.S., 1971–2006...................................... 51

3–53 Hospital Case-Fatality Rate for Stroke, Ages Younger Than 65 and 65 and Over, 

U.S., 1971–2006............................................................................................................................................ 52
x

3–54 Age-Adjusted Death Rates for Stroke by Race and Sex, U.S., 1950–2006.................................................. 53

3–55 Deaths and Age-Adjusted Death Rates for Stroke, U.S., 1979–2006........................................................... 54

3–56 Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 1999–2006.................................. 55

3–57 Average Annual Percent Change in Age-Adjusted Death Rates for Stroke by Race

and Sex, U.S., 1960–2006............................................................................................................................. 55

3–58 Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 2006............................................ 56

3–59 Death Rates for Stroke in Males by Age and Race/Ethnicity, U.S., 2006 .................................................... 56

3–60 Death Rates for Stroke in Females by Age and Race/Ethnicity, U.S., 2006................................................. 56

3–61 Age-Adjusted Death Rates for Stroke by State, U.S., 2003–2005................................................................ 57

3–62 Age-Adjusted Death Rates for Stroke by Country and Sex, Ages 35–74, 2007........................................... 58

3–63 Change in Age-Adjusted Death Rates for Stroke in Males by Country, Ages 35–74, 

1999–2007........................................................................................................................................................ 58

3–64 Change in Age-Adjusted Death Rates for Stroke in Females by Country, Ages 35–74, 

1999–2007........................................................................................................................................................ 59

3–65 Prevalence of Hypertension and Prehypertension by Age, U.S., 1999–2006............................................... 59

3–66 Age-Adjusted Prevalence of Hypertension by Race/Ethnicity and Sex, Ages 20–74, 

U.S., 1999–2006............................................................................................................................................ 60

3–67 Age-Adjusted Prevalence of Hypertension by Race/Ethnicity and Sex, Ages 20–74, 

U.S., 1976–1980 to 2003–2006 .................................................................................................................... 60

3–68 Hypertensive Population Aware, Treated, and Controlled, Ages 18–74, U.S., 1971–1972 

to 2003–2006................................................................................................................................................. 61

3–69 Hypertensive Population Aware, Treated, and Controlled, Ages 18–74, U.S., 1976–1980 

to 2003–2006................................................................................................................................................. 61

3–70 Age-Adjusted Death Rates for Diseases of the Arteries by Race and Sex, U.S., 2006 ................................ 61

3–71 Death Rates for Diseases of the Arteries by Age, Race, and Sex, U.S., 2006 .............................................. 62

3–72 Percent of Deaths From Congenital Malformations of the Circulatory System, Age Under 1, 

U.S., 1940–2006............................................................................................................................................ 62

3–73 Infant Mortality From Congenital Malformations of the Circulatory System by Race, 

U.S., 1970–2006............................................................................................................................................ 63

4. Lung Diseases

4–1 Deaths From Lung Diseases, Percent by Subgroup, U.S., 2006................................................................... 65

4–2 Number of Hospitalizations, Physician Office Visits, and Deaths for Lung Diseases, U.S., 2006............... 65

4–3 Age-Adjusted Death Rates for Total Lung Diseases by Race and Sex, U.S., 2006...................................... 66

4–4 Death Rates for Total Lung Diseases by Age, Race, and Sex, U.S., 2006.................................................... 66

4–5 Prevalence of Chronic Obstructive Pulmonary Disease by Age, U.S., 1997–2007...................................... 66

4–6 Prevalence of Chronic Obstructive Pulmonary Disease by Age, Race, and Sex, U.S., 2007....................... 67

4–7 Hospitalization Rates for Chronic Obstructive Pulmonary Disease, Ages 45–64 and 

65 and Older, U.S., 1995–2006..................................................................................................................... 67
xi

4–8 Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Race and Sex, 

U.S., 1960–2006............................................................................................................................................ 68

4–9 Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Race/Ethnicity 

and Sex, U.S., 1999–2006............................................................................................................................. 69

4–10 Death Rates for Chronic Obstructive Pulmonary Disease in White Males by Age, U.S., 

1960–2006..................................................................................................................................................... 70

4–11 Death Rates for Chronic Obstructive Pulmonary Disease in Black Males by Age, U.S., 

1960–2006..................................................................................................................................................... 71

4–12 Death Rates for Chronic Obstructive Pulmonary Disease in White Females by Age, U.S., 

1960–2006..................................................................................................................................................... 72

4–13 Death Rates for Chronic Obstructive Pulmonary Disease in Black Females by Age, U.S., 

1960–2006..................................................................................................................................................... 73

4–14 Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by State, U.S., 

2003–2005..................................................................................................................................................... 74

4–15 Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Country 

and Sex, Ages 35–74, 2007........................................................................................................................... 75

4–16 Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Race/Ethnicity 

and Sex, U.S., 2006....................................................................................................................................... 75

4–17 Death Rates for Chronic Obstructive Pulmonary Disease by Age, Race, and Sex, 

U.S., 2006...................................................................................................................................................... 76

4–18 Prevalence of Asthma Ages Younger Than 18 and 18 and Older, U.S., 1980–2007 .................................... 76

4–19 Prevalence of Asthma by Race, U.S., 1980–2007 ........................................................................................ 77

4–20 Prevalence of Current Asthma by Race/Ethnicity and Sex, Ages Younger Than 18, 

U.S., 2006...................................................................................................................................................... 77

4–21 Prevalence of Current Asthma by Race/Ethnicity and Sex, Ages 18 and Older, 

U.S., 2006...................................................................................................................................................... 78

4–22 Physician Office Visits for Asthma, U.S., 1990–2006 .................................................................................. 78

4–23 Hospitalizations for Asthma by Primary and Secondary Diagnosis, U.S., 1980–2006 ................................ 79

4–24 Hospitalizations for Asthma by Age, U.S., 1980–2006 ................................................................................ 80

4–25 Age-Adjusted Death Rates for Asthma by Race and Sex, U.S., 2006.......................................................... 80

4–26 Age-Adjusted Death Rates for Asthma by Race and Sex, Ages 1–24, U.S., 1980–2006............................. 81

4–27 Age-Adjusted Death Rates for Asthma by Race and Sex, U.S., 1980–2006................................................ 82

4–28 Death Rates for Asthma by Age, Race, and Sex, U.S., 1999–2006.............................................................. 83

4–29 Age-Adjusted Death Rates for Asthma by Country and Sex, 2007.............................................................. 83

4–30 Infant Mortality Rate for Respiratory Distress Syndrome, U.S., 1968–2006............................................... 84

4–31 Infant Mortality Rate for Respiratory Distress Syndrome by Race, U.S., 1980–2006................................. 85

4–32 Infant Mortality Rate for Respiratory Distress Syndrome by Race/Ethnicity, U.S., 2005 ........................... 86

4–33 Infant Mortality Rate for Sudden Infant Death Syndrome by Race/Ethnicity, 

U.S., 2005...................................................................................................................................................... 86
xii

5. Blood Diseases 

5–1 Blood Disease Deaths, Percent by Subgroup, U.S., 2006............................................................................. 87

5–2 Number of Hospitalizations, Physician Office Visits, and Deaths for Blood Diseases, 

U.S., 2006...................................................................................................................................................... 88

5–3 Hospitalizations for Aplastic Anemia by Primary and Secondary Diagnosis, U.S., 1982–2006.................. 89

5–4 Age-Adjusted Death Rates for Aplastic Anemia by Race and Sex, U.S., 2003–2006.................................. 89

5–5 Death Rates for Aplastic Anemia by Age, Race, and Sex, U.S., 2003–2006................................................ 90

5–6 Hospitalization Rates for Sickle Cell Anemia in Blacks, Ages Younger Than 15 

and 15–44, U.S., 1982–2006......................................................................................................................... 90

5–7 Age-Adjusted Death Rates for Sickle Cell Anemia in Blacks by Sex, U.S., 

1980–1984 to 2003–2006.............................................................................................................................. 91

5–8 Death Rates for Sickle Cell Anemia in Blacks by Age and Sex, U.S., 2003–2006 ...................................... 91
1

1. Introduction

During the past 40 years, major advances have been made in the prevention, diagnosis, and treatment of cardiovascular, lung, and blood diseases. Death rates from cardiovascular diseases (CVD) have declined significantly, 

and Americans are living longer, healthier lives. Despite the tremendous progress that has been made, morbidity 

and mortality from cardiovascular, lung, and blood diseases continue to impose a major burden on patients, their 

families, and the national health care system. The economic cost to the nation is substantial. 

This Chart Book provides data that show the magnitude of the problem and time trends that highlight demographic differences in disease burden by age, sex, and racial/ethnic status. Nationally collected data are presented 

by race and ethnicity to the extent they are available, statistically reliable, and consistently collected.

A companion chart book, Incidence and Prevalence: 2006 Chart Book on Cardiovascular and Lung Diseases, 

represents a compendium of data from six cohort community studies and one surveillance study supported by the 

NHLBI.1

The “Background Data” chapter provides population and life-expectancy estimates; trends in total mortality, mortality by selected causes or major diagnosis, and days of hospital care; leading causes of death and chronic conditions; prevalence of CVD risk factors; and economic cost data. The “Cardiovascular Diseases,” “Lung Diseases,” 

and “Blood Diseases” chapters contain detailed morbidity and mortality statistics by racial/ethnic group, sex, and 

geographic distribution. Diseases included in a chapter are listed in the first table of the chapter, together with 

appropriate diagnostic codes of the ninth revision of the clinical modification of the International Classification 

(ICD-9-CM) for hospitalizations and physician office visit data, and tenth revision of the International 

Classification of Diseases (ICD) of the World Health Organization (WHO) for mortality.2,3

Sources of Data

Most of the data used in this book were obtained from the National Center for Health Statistics (NCHS). 

Specifically, data include the annual vital statistics of the United States; the annual National Health Interview 

Survey (NHIS); the National Health and Nutrition Examination Survey (NHANES), 1971–1975, 1976–1980, 

1988–1994, 1999–2002, and 2003–2006; the annual National Hospital Discharge Survey (NHDS); and the annual 

National Ambulatory Medical Care Survey. International mortality data came from the WHO Web site.

It is beyond the scope of the Chart Book to cite all of the NCHS and Bureau of the Census publications, data 

tapes, and Web sites that were used to prepare this document. Specific data sources for current statistics and 

general references to hospital and prevalence surveys and vital statistics for earlier data years may be found in 

Appendix E.

Population Estimates

The NCHS and the NHLBI used annual mid-year U.S. population estimates from the Bureau of the Census to 

express morbidity and mortality per population. Prevalence and hospital discharge statistics are based on noninstitutionalized population estimates that were included in NCHS publications. The annual live births are reported 

by NCHS and used for infant mortality rates.

Population counts from the 2000 Census and estimates based on it thereafter have been bridged to single race 

categories, combining multiple race categories found in the Census.

Quality of Data

Quality issues discussed below include accuracy of diagnosis, data comparability, and ICD classification.
2

Prevalence

Diagnosis for most disease prevalence and smoking habits are based only on self-reports from health interviews. 

Physical measurements, on the other hand, are used to determine the prevalence of cardiovascular risk factors, 

such as high serum cholesterol and overweight. Prevalence of hypertension is based on blood pressure readings 

and health interviews about relevant medication. 

Hospital Statistics

Hospitalization statistics measure rates of health care use, length of stay, and hospital case fatality. They have 

limitations associated with diagnostic accuracy (e.g., the diagnosis may be influenced by the billing process) and 

diagnostic comparability over time (e.g., ICD revisions). Time trends may not accurately reflect real changes in 

incidence and case-fatality because data occasionally include changes in hospital admission practices. 

Charts that show hospitalization rates are based on first-listed diagnoses on the hospital record (i.e., primary diagnosis). Charts that show the numbers of hospitalizations for a particular disease include those that are classified as 

the primary diagnosis and those that are classified as secondary to some other disease.

Methodological problems in data collection preclude the presentation of hospital data by race.4 

In 1988, the NCHS redesigned the NHDS to link it with other surveys conducted by NCHS and to improve efficiency. The new survey occasionally resulted in a sudden shift in the level of rates after 1987.5

 For this reason, 

charts display a break in the trend lines for hospitalization rates between the 

transitional years 1987–1988.

The term hospitalizations, which replaces the NHDS term hospital discharges, refers to all inpatients, whether 

discharged alive or dead. The diagnosis given at discharge is the one that is used. Because the Survey is eventbased rather than patient-based, annual estimates pertain to numbers of hospitalizations, not to numbers of patients 

hospitalized in a given year. 

Cause-of-Death Statistics

Limitations of cause-of-death statistics, apart from discontinuities over time caused by revisions in the ICD, are 

well known. Inaccuracies in death certification and inconsistencies in selecting and coding the underlying cause 

of death create uncertainties about the true mortality from a specific cause compared with other causes. These 

uncertainties must be kept in mind when comparing the same cause of death over time or the same cause of death 

between demographic groups or countries. 

Selecting only one cause of death as the underlying cause has the advantage of diagnostic specificity but the disadvantage of an incomplete account of the various causes that contributed to a death. Almost all mortality statistics presented here are limited to the underlying cause because that provides the consistency needed for the best 

comparison among causes of death. 

Heart failure, which is nominally classified as the underlying cause for some deaths only because the true underlying cause was not known, is an exception (see Chapter 3). Heart failure mortality is presented two ways: As the 

underlying cause and as “any mention” cause. “Any mention” mortality means that the condition was selected as 

the underlying cause or was otherwise mentioned on the death certificate. 

Another limitation related to cause-of-death statistics involves international comparisons of vital statistics. 

Comparisons of mortality data for coronary heart disease (CHD), stroke, and chronic obstructive pulmonary disease (COPD) among countries are affected by differences in diagnostic practices and physician training, interpretation of internationally recommended rules for coding a cause of death, availability of diagnostic aids, and the 

use of autopsies. Information presented in this book is limited to countries that are known to produce high-quality 

statistics.
3

Inconsistent race identification between death certificates and data from the Bureau of the Census and undercounts 

of some population groups in the Census may cause over- or underestimation of death rates in racial groups.6

Beginning in 1989, the U.S. Standard Certificate of Death was revised. One reason was to improve the medical 

certification of cause of death.7

 Because the revision could affect time–trend comparability, mortality trend lines 

between 1988 and 1989 are not connected.

ICD Revisions

Revisions in the ICD codes (Appendix A) cause discontinuity in time trends, particularly those associated with 

mortality. In charts where more than one ICD revision has been used, breaks in trend lines have been added 

between revisions or comparability ratios have been applied. Where differences in mortality classification 

between ICD-9 (1979–1998) and ICD-10 (1999–) exceed 4% (stroke and COPD in Charts 2–5, 3–5, and 3–55), 

NCHS-derived comparability ratios (Appendix B) have been applied to the death rates coded by ICD-9.8 

Data Presentation

Mortality data (rates per population) are generally expressed by age, race/ethnicity, and sex. Age-adjusted mortality data (rates per population or percent change) are expressed by race/ethnicity and sex and in a few cases by 

States. Prevalence data are given as a percent of population and are expressed by age, race/ethnicity, and sex. 

Hospitalization data are shown as comparisons between age groups or by primary or secondary diagnoses.

Rates per Population

Death rates are expressed per 100,000 population, using the resident population as of July 1 of the relevant year as 

the denominator. Hospital discharge rates are expressed per 10,000 population, and the number of discharges is 

the denominator for percent discharged dead. Infant mortality rates are expressed per 100,000 live births.

Age Adjustment 

Age-adjusted rates are used to compare prevalence or mortality among various population groups or for one group 

over time. The 2000 standard population is applied in the age-adjustment so that rates are not affected by differences in age composition among the populations.9–11 The European standard population is applied for age adjustment of international mortality statistics.12

The major disadvantage of using age-adjusted rates is loss of age-specific information. This becomes evident 

when the population groups being compared have mortality differences that are not in the same direction over a 

given age range. For example, the bar chart for mortality from total lung diseases (Chart 4–3) has a higher ageadjusted rate for white females than for black females. The age-specific line chart (Chart 4–4), however, shows 

that for ages 35–64 years, black females have higher rates than white females, but for ages 65–84 years, white 

females have higher rates than black females. 

Percent Change

Percent changes in death rates over time, whether between 2 specified years or on an average annual basis, are 

calculated from log-linear regression slopes of rates for each year of a selected period.13 The percent changes may 

be influenced by unusually high or low values, especially if the period is short, and do not provide information 

about the levels on which they are based, which might be small. Average annual percent changes should not be 

summed over a period because the sum will be more than the percent change from the first to the last year in the 

period. Average annual percent changes give the appearance of small differences in the comparisons being made. 

An exception to the use of log-linear regression to calculate percent change is made for Chart 3–6. For this chart, 

it is useful to have the percent change and other calculations based on the actual death rates.
4

Horizontal and Vertical Scales

Comparisons between time–trend charts are complicated because the range of the vertical scale may differ 

between charts. Vertical scales for less common diagnoses are magnified to focus on differences by age, race, and 

sex.

Arithmetic and Logarithmic Scales

In this Chart Book, time trends in death rates are plotted on an arithmetic scale to show their absolute change relative to zero. Note, however, that on an arithmetic scale, the absolute increase or decrease for a smaller death rate 

may appear to be modest compared with the change for a larger death rate, when in fact, the percent change over 

time is greater for the smaller rate. In addition, on an arithmetic scale, a decline can appear to be slowing, but if 

plotted on a logarithmic scale, it would not. 

Truncated Age Ranges

The age range for death rates in some charts excludes individuals older than 84 years because of the difficulty 

associated with obtaining accurate diagnoses for patients who often have other contributing comorbidities. 

Selected truncated age groups are frequently used for U.S. data to highlight specific premature adult morbidity 

and mortality. For international comparisons, the age range 35–74 years was chosen so that differing age distributions among countries would be minimized in rate calculations.

Demographic Characteristics

The Chart Book provides prevalence and mortality information for various racial and ethnic groups. Several 

charts show comparisons between blacks and whites. 

However, for mortality prior to 1968, data for nonwhites instead of blacks are presented. Many charts provide a 

race/sex comparison. Others present data for total males and total females or for total whites and total blacks to 

highlight important points that otherwise would be lost if four-way combinations were used. 

The term American Indian is used to refer to the population that consists of American Indians and Alaska Natives. 

The term Asian is used to include persons of Asian and Pacific Islander descent. Data on socioeconomic groups 

are not presented because they are extensively presented elsewhere.14

State Mortality

Death rates for total population by State are shown in maps for CVD, CHD, stroke, and COPD.15 Although State 

death rates that combine all age, race, and sex groups can be misleading, they do show a reasonably similar geographic pattern compared with maps that are either race and sex specific or confined to a specific age range (not 

shown). For instance, stroke mortality is high in Southern States, reflecting high mortality in both blacks and 

whites. Although rankings of certain States for CHD mortality differ considerably from rankings for total heart 

disease, their geographic patterns are not very different.16
5

2. Background Data

The charts in this chapter provide population estimates, life expectancy, morbidity and mortality, and economic 

cost data for cardiovascular, lung, and blood diseases. Most focus on the leading causes of death, but a few 

address specific CVD risk factors. Immediately below are selected prevalence and incidence estimates.

Cardiovascular Diseases 

Table 2–1 contains prevalence estimates for CVD in the U.S. population.17–21 It should be noted that individuals 

with multiple CVD are counted for each condition that applies to them. 

Table 2–1. CVD Prevalence, U.S.

CVD 81,100,000

Hypertension 74,500,000

CHD 17,600,000

Acute Myocardial Infarction (AMI) 8,500,000

Angina Pectoris 10,200,000

Stroke 6,400,000

Heart Failure 5,800,000

Congenital Heart Defects 1,000,000

Atrial Fibrillation 2,200,000

Peripheral Arterial Disease 8,000,000

Table 2–2 contains estimates for the annual 

occurrence of CVD in the United States.21–23

Table 2–2. CVD Incidence and Recurrence, U.S.

Heart Attack 1,255,000

First Event 785,000

Recurrent Event 470,000

Stroke 795,000

First Event 610,000

Recurrent Event 185,000

Heart Failure 670,000

First Event 670,000

Lung Diseases

An estimated 24 million U.S. adults have COPD: 12 million physician-diagnosed and 12 undiagnosed.24–25 An 

estimated 23 million individuals have asthma and 12 million of them experienced at least one asthma attack during the survey year.26–28 Approximately 30,000 people have cystic fibrosis, and 1 in 3,000 babies are born with the 

disease; 40,000 infants and 150,000 adults have respiratory distress syndrome; and about 12 million persons have 

obstructive sleep apnea.

In this chapter, charts showing leading causes of death combine asthma with COPD and list the category as 

COPD and allied conditions. The ICD-10 term is chronic lower respiratory diseases.
6

Blood Diseases

An estimated 70,000 blacks have sickle cell anemia, and 1 in 500 black babies is born with the disease annually. 

About 500 to 1,000 persons develop aplastic anemia each year. Approximately 18,000 persons have hemophilia, 

and 400 babies are born with the disease each year. About 1,000 persons have Cooley’s anemia.

Population 

Population estimates in Chart 2–1 are based on the 2000 U.S. Census and population surveys and projections. 

Estimates in Chart 2–1 and 2–2 reflect the 1997 Office of Management and Budget directive on race and ethnicity 

that allows survey respondents in Federal data collection programs to select more than one race. For Chart 2–3, 

designations of race were modified by NCHS to be consistent with the directive.

Chart 2–1 

Total Population by Mean Age, Percent Age 65 and Older, Race/Ethnicity, and Sex, U.S., 2007

In 2007, the mean age and percent population aged 65 years and older were lower for minorities than for whites. 

This was true for both males and females.29

    Total Population Male Female

    Pop.

(Mil.)

Mean

Age

Percent

65

Pop.

(Mil.)

Mean

Age

Percent

65

Pop.

(Mil.)

Mean

Age

Percent

65

Total 301.6 36.8 12.6 148.6 35.6 10.8 153.0 38.0 14.3 

White 241.2 38.4 13.7 119.5 37.2 11.7 121.6 39.6 15.6 

Hispanic (42.1) (28.6) (5.6) (21.8) (29.1) (4.6) (20.3) (30.2) (6.7)

Non-Hispanic (199.1) (40.2) (15.4) (97.7) (39.0) (13.3) (101.3) (41.5) (17.4)

Black 38.8 32.2 8.1 17.9 30.8 6.5 19.6 33.6 9.6 

Hispanic (1.7) (28.3) (5.0) (0.8) (27.3) (4.1) (0.9) (29.2) (5.5)

Non-Hispanic (37.0) (33.0) (8.5) (17.6) (31.4) (6.8) (19.4) (34.4) (10.0)

American Indian* 2.9 32.9 7.2 1.5 32.2 6.4 1.5 33.5 8.1 

Asian* 13.4 36.0 9.2 6.5 35.0 8.2 6.9 37.0 10.2 

Hispanic† 45.5 29.5 5.5 23.5 29.0 4.6 22.0 30.1 6.5 

* Estimates for Hispanic American Indians and Hispanic Asians are not available.

†

 Hispanic can be of any race.
7

Chart 2–2

Total Projected Population by Mean Age, Percent Age 65 and Older, Race/Ethnicity, and Sex, U.S., 

2020

By 2020, the U.S. population will be 19.4% Hispanic, 13.0% black, and 5.5% Asian, and 16.1% will be aged 65 

and older.30

    Total Population Male Female

    Pop.

(Mil.)

Mean

Age

Percent

65

Pop.

(Mil.)

Mean

Age

Percent

65

Pop.

(Mil.)

Mean

Age

Percent

65

Total 341.6 38.4 16.1 168.3 37.3 14.5 173.1 39.4 17.6

White 266.3 39.3 17.4 132.2 38.3 15.8 134.1 40.3 19.0

Hispanic (61.0) (31.1) (7.7) (30.9) (30.6) (6.7) (30.1) (31.6) (8.7)

Non-Hispanic (205.3) (41.8) (20.3) (101.3) (40.7) (18.6) (103.9) (42.8) (22.0)

Black 44.4 35.3 11.4 21.3 33.8 9.4 23.1 36.8 13.3

Hispanic (2.5) (29.7) (6.9) (1.2) (28.6) (5.9) (1.3) (30.7) (7.8)

Non-Hispanic (41.8) (35.7) (11.7) (20.0) (34.1) (9.6) (21.8) (37.2) (13.6)

American Indian* 3.8 33.8 10.9 1.9 33.1 9.9 1.9 34.6 12.0

Asian* 18.8 38.2 13.0 8.8 37.1 11.8 10.0 39.2 14.1

Hispanic† 66.4 30.9 7.6 33.6 30.3 6.6 32.8 31.4 8.6

* Estimates for Hispanic American Indians and Hispanic Asians are not available.

†

 Hispanic can be of any race.

Chart 2–3

Average Remaining Lifetime Years by Age, Race, and Sex, U.S., 2006

In 2006, average life expectancy at birth was 77.7 years—80.4 years for females compared with 75.1 for males, 

and 78.2 years for whites compared with 73.2 years for blacks.31

Age (Years) Total Male Female

Total

White

White

Male

White

Female

Total

Black

Black

Male

Black

Female

Birth 77.7 75.1 80.4 78.2 75.7 80.6 73.2 69.7 76.5

15 63.4 60.9 65.9 63.8 61.3 66.1 59.5 56.0 62.7

35 44.4 42.2 46.4 44.7 42.6 46.7 40.9 37.9 43.5

65 18.5 17.0 19.7 18.6 17.1 19.8 17.1 15.1 18.6

75 11.6 10.5 12.3 11.5 10.5 12.3 11.1 9.8 12.0
8

Chart 2–4 

Age-Adjusted Death Rates for All Causes by Race and Sex, U.S., 1950–2006

From 1950 to 2006, all-cause death rates declined for males, females, blacks, and whites. Males had higher 

mortality rates than females, and for both sexes, blacks had higher mortality rates than whites.15, 32

    Deaths/100,000 Population

Year

Black*

Male

White

Male

Black*

Female

White

Female

1950 1,949.5 1,642.5 1,574.1 1,184.0

1951 1,902.4 1,621.7 1,539.4 1,178.6

1952 1,889.8 1,588.5 1,496.0 1,157.0

1953 1,865.3 1,589.0 1,469.0 1,146.5

1954 1,726.6 1,516.3 1,326.3 1,081.8

1955 1,707.5 1,544.7 1,326.7 1,095.4

1956 1,724.1 1,554.3 1,331.9 1,089.9

1957 1,797.0 1,581.7 1,374.6 1,104.1

1958 1,779.2 1,573.1 1,354.6 1,090.8

1959 1,724.6 1,552.1 1,304.9 1,065.2

1960 1,777.6 1,586.0 1,334.6 1,074.4

1961 1,725.2 1,547.3 1,296.4 1,038.8

1962 1,801.7 1,579.1 1,324.5 1,052.6

1963 1,859.0 1,614.7 1,347.8 1,062.6

1964 1,768.0 1,572.0 1,282.7 1,030.8

1965 1,791.0 1,589.9 1,266.0 1,026.7

1966 1,832.4 1,595.7 1,274.9 1,024.7

1967 1,767.2 1,566.9 1,209.7 992.9

1968 1,876.9 1,581.8 1,277.5 1,029.4

1969 1,814.1 1,549.8 1,274.9 1,008.4

1970 1,872.8 1,513.7 1,229.4 944.0

1971 1,836.1 1,514.4 1,196.8 933.4

1972 1,871.8 1,520.2 1,181.2 878.9

1973 1,849.5 1,507.2 1,179.7 921.4

1974 1,769.5 1,450.8 1,109.7 884.2

1975 1,697.0 1,391.0 1,042.4 834.1

1976 1,676.0 1,379.5 1,031.2 828.9

1977 1,647.9 1,343.5 1,012.2 799.7

1978 1,625.6 1,332.5 954.4 796.6

1979 1,604.5 1,289.6 969.2 770.2

1980 1,697.8 1,317.6 1,033.3 796.1

1981 1,626.6 1,282.2 986.6 773.6

1982 1,580.4 1,255.9 960.1 758.7

1983 1,600.7 1,259.4 980.7 763.9

1984 1,600.8 1,245.9 976.9 760.7

1985 1,634.5 1,249.8 994.4 764.3

1986 1,650.1 1,230.4 994.4 758.1

1987 1,650.3 1,213.4 989.7 753.3

1988 1,677.6 1,215.9 1,006.8 759.0

1989 1,670.1 1,176.6 998.1 738.8

1990 1,644.5 1,165.9 975.1 728.7

1991 1,622.0 1,146.4 968.0 719.8

1992 1,591.4 1,125.6 954.4 709.5

1993 1,629.3 1,143.0 977.7 728.9

1994 1,589.8 1,123.4 965.0 723.5

1995 1,582.3 1,112.7 970.1 726.6

1996 1,513.9 1,086.1 956.3 723.3

1997 1,446.7 1,062.5 940.7 718.3

1998 1,410.6 1,038.5 938.2 715.1

1999 1,432.6 1,040.0 933.6 716.6

2000 1,403.5 1,029.4 927.9 715.3

2001 1,375.0 1,006.1 912.5 706.7

2002 1,341.4 992.9 901.8 701.3

2003 1,319.1 973.9 885.6 693.1

2004 1,269.4 936.9 855.3 666.9

2005 1,252.9 933.2 845.7 666.5

2006 1,215.6 908.2 813.0 648.2

* Nonwhite from 1950 to 1967
9

Chart 2–5 

Unadjusted Death Rates for Selected Causes, U.S., 1950–2006

From 1950 to the mid-1960s, the unadjusted death rate for CHD increased but remained fairly stable for stroke. 

After 1968, death rates for CHD and stroke began to decline. CHD mortality continued to decline but stroke 

mortality reached a plateau in the 1990s before declining again in the 2000s. In contrast, the death rate for COPD 

steadily increased from 1950 until it began to plateau in the late 1990s.15, 32

    Deaths/100,000 Population

Year CHD Stroke

Lung 

Cancer

Other 

Cancer COPD

1950 262.8 104.0 12.2 127.6 2.1

1951 265.8 106.7 12.9 127.6 2.4

1952 269.6 106.8 13.9 129.5 2.4

1953 277.2 107.3 14.9 129.8 2.9

1954 272.2 104.1 15.4 130.2 3.1

1955 282.7 106.0 16.3 130.2 3.4

1956 289.2 106.3 17.4 130.4 3.9

1957 298.7 110.2 18.1 130.5 4.8

1958 296.8 110.1 18.6 128.2 5.4

1959 297.4 108.4 19.4 127.9 5.9

1960 304.7 108.0 20.3 128.9 6.9

1961 301.6 105.4 21.3 128.1 7.2

1962 311.1 106.3 22.3 127.6 8.6

1963 317.6 106.7 23.1 128.2 10.3

1964 311.2 103.7 24.0 127.3 10.6

1965 314.0 103.9 25.0 128.4 12.1

1966 318.5 104.7 26.3 128.8 12.9

1967 315.0 102.4 27.6 129.6 13.3

1968 338.4 106.0 29.8 130.0 15.2

1969 332.6 102.9 30.7 129.7 15.6

1970 328.1 101.9 32.1 130.7 16.2

1971 326.0 101.1 33.2 129.8 16.7

1972 327.0 101.9 34.7 130.2 17.5

1973 323.7 101.4 35.5 130.4 18.5

1974 311.6 97.2 37.0 131.7 18.4

1975 298.3 90.1 38.1 131.2 19.1

1976 297.0 86.7 39.7 133.1 20.2

1977 290.5 82.8 41.2 134.2 20.3

1978 289.2 79.1 42.8 135.9 21.9

1979 275.0 75.3 43.8 135.8 22.2

1980 280.6 75.0 45.8 138.1 24.7

1981 272.0 71.1 46.4 137.5 25.6

1982 268.0 67.9 48.1 139.2 25.8

1983 267.3 66.4 49.2 140.3 28.3

1984 260.0 65.3 50.3 142.0 29.3

1985 255.7 64.2 51.5 142.5 31.4

1986 247.1 62.2 52.3 143.2 31.9

1987 241.3 61.7 53.7 143.2 32.3

1988 238.2 61.4 54.5 143.9 33.9

1989 230.5 58.8 55.6 145.5 34.2

1990 224.5 57.8 56.8 146.4 34.8

1991 219.3 56.6 56.8 146.6 35.8

1992 214.0 55.9 56.9 146.0 35.8

1993 216.5 57.6 57.3 146.6 38.9

1994 210.0 58.1 56.8 146.3 38.6

1995 207.5 59.2 56.8 145.4 38.6

1996 202.2 59.2 56.4 143.9 39.3

1997 195.5 58.5 56.2 141.7 40.0

1998 190.9 57.3 56.0 140.3 40.8

1999 189.8 60.0 55.5 145.3 42.8

2000 183.1 59.6 56.1 143.5 41.8

2001 176.3 57.4 55.3 140.7 41.7

2002 171.4 56.4 54.9 138.6 41.8

2003 165.1 54.2 54.1 136.0 42.1

2004 153.7 51.1 53.2 132.6 40.2

2005 150.4 48.4 53.7 135.0 42.9

2006 142.1 45.8 53.0 134.0 40.4
10

Chart 2–6 

Number of Days of Inpatient Hospital Care by Major Diagnosis, U.S., 1990–2006

From 1990 to 2006 (except in 1994), cardiovascular and respiratory diseases ranked first and second, respectively, 

in the number of days for which patients received hospital care.33, 34

    Days of Care (Millions)

Year Cardiovascular Respiratory Mental Digestive

Injury and 

Poisoning Neoplasms Musculoskeletal Endocrine

1990 37.9 20.4 18.8 19.2 18.9 16.8 10.2 7.6

1991 39.0 20.7 19.0 19.3 19.1 16.4 10.2 8.1

1992 39.4 19.8 18.6 18.4 16.9 15.4 10.0 7.5

1993 37.5 21.1 18.8 17.5 17.3 13.6 9.0 8.0

1994 36.1 19.6 20.9 16.8 15.2 13.2 8.2 7.4

1995 33.6 19.9 17.9 15.8 14.6 11.8 7.3 6.8

1996 33.7 19.2 16.5 14.7 13.8 11.2 7.2 6.8

1997 32.5 19.6 15.6 14.6 13.2 10.9 6.8 6.6

1998 32.6 19.2 15.1 14.7 13.6 10.8 6.5 6.3

1999 30.8 20.1 15.1 15.1 13.8 10.5 6.7 6.6

2000 30.4 18.5 15.8 14.9 13.4 9.3 6.3 6.6

2001 29.3 18.2 17.3 15.5 13.9 10.0 6.6 6.7

2002 29.9 18.8 17.5 16.2 14.2 10.2 6.8 6.9

2003 30.0 19.6 16.5 16.4 14.8 10.0 7.5 7.5

2004 29.8 18.4 16.5 16.8 15.5 9.4 7.4 7.0

2005 28.2 19.5 16.6 16.2 14.8 9.6 7.6 6.8

2006 27.4 17.7 17.0 16.3 16.0 9.5 7.6 6.5

Chart 2–7 

Age-Adjusted Death Rates by Major Diagnosis, U.S., 1990–2006

From 1990 to 2006, age-adjusted death rates for cardiovascular and respiratory diseases ranked first and third, 

respectively.15, 35

    Deaths/100,000 Population

Year Cardiovascular Neoplasms Respiratory

Injury and 

Poisoning Endocrine Digestive Mental Musculoskeletal

1990 412.5 219.0 85.5 60.4 27.7 33.1 11.9 3.4

1991 401.6 218.7 84.5 59.3 28.0 32.5 12.2 3.3

1992 392.3 217.3 82.3 57.4 28.2 32.1 12.7 3.2

1993 397.6 217.6 87.8 58.9 29.8 31.7 14.3 3.4

1994 387.1 216.1 86.0 58.3 30.7 31.4 15.5 3.5

1995 384.3 214.7 85.9 57.8 31.6 30.7 16.7 3.7

1996 375.5 211.6 86.2 56.9 32.2 30.3 17.5 3.7

1997 366.0 208.6 87.6 56.1 32.5 30.4 18.5 3.9

1998 355.2 205.4 89.6 55.7 33.0 29.8 20.0 3.8

1999 350.7 205.6 84.3 54.3 34.0 30.3 15.5 4.9

2000 341.3 204.5 83.7 53.9 34.1 30.4 16.7 5.0

2001 328.2 200.5 81.6 56.1 34.3 30.3 17.8 5.0

2002 319.0 196.1 81.4 56.7 34.4 30.0 19.2 5.0

2003 307.7 194.7 80.5 57.0 34.2 29.8 20.2 4.9

2004 288.0 190.4 76.1 57.3 33.1 28.8 20.3 4.8

2005 278.9 188.3 78.5 58.7 33.7 28.4 22.8 4.7

2006 262.5 185.3 72.6 59.6 31.8 27.9 28.6 4.5
11

Chart 2–8 

Leading Causes of Death, U.S., 2006

In 2006, heart disease, stroke, and COPD and allied conditions were the first, third, and fourth leading causes of 

death, respectively.32

Cause of Death Number

Total deaths 2,426,264

Heart disease* 631,636

Cancer 559,888

Cerebrovascular disease (stroke) 137,119

COPD and allied conditions† 124,583

Accidents 121,599

Diabetes 72,449

Alzheimer’s disease 72,432

Influenza and pneumonia 56,326

Nephritis 45,344

Septicemia 34,234

All other causes of death 570,654

* Includes 425,425 deaths from CHD.

†

 Chronic lower respiratory diseases.

Chart 2–9 

Leading Causes of Death by Age and Rank, U.S., 2006

In 2006, heart disease was the third leading cause of death for those aged 25–44 years, second for those aged 

45–64 years, and first for those aged 65 years and older. Stroke ranked fifth for those aged 45–64 years and third 

for those aged 65 years and older. COPD and allied conditions ranked sixth for those aged 45–64 years and fourth 

for those aged 65 years and older.31

Cause of Death 1–24 25–44 45–64 65

Heart disease 5 3 2 1

Cancer 4 2 1 2

Cerebrovascular disease 8 9 5 3

Accidents 1 1 3 9

COPD and allied conditions* 9 — 6 4

Influenza and pneumonia 7 10 — 7

Diabetes mellitus — 8 4 6

Suicide 3 4 8 —

Chronic liver disease — 7 7 —

Nephritis and nephrosis — — 9 8

Homicide 2 5 — —

Septicemia 10 — 10 10

Congenital malformations 6 — — —

Alzheimer’s disease — — — 5

* Chronic lower respiratory diseases.
12

Chart 2–10 

Leading Causes of Death, White Males, U.S., 2006

In 2006, among white males, heart disease, COPD and allied conditions, and stroke were the first, fourth, and fifth 

leading causes of death, respectively.36 

Cause of Death Percent of All Deaths

Heart disease 26.6

Cancer 24.5

Accidents 6.5

COPD and allied conditions* 5.3

Stroke 4.4

Diabetes 2.8

* Chronic lower respiratory diseases.

Chart 2–11

Leading Causes of Death, White Females, U.S., 2006

In 2006, among white females, heart disease, stroke, and COPD and allied conditions were the first, third, and 

fourth leading causes of death, respectively.36

Cause of Death Percent of All Deaths

Heart disease 26.0

Cancer 22.0

Stroke 6.7

COPD and allied conditions* 5.8

Alzheimer's disease 4.5

Accidents 3.5

* Chronic lower respiratory diseases.

Chart 2–12 

Leading Causes of Death, Black Males, U.S., 2006

In 2006, among black males, heart disease and stroke were the first and fifth leading causes of death, 

respectively.36

Cause of Death Percent of All Deaths

Heart disease 24.4

Cancer 21.9

Accidents 6.5

Homicide 5.2

Stroke 5.0

Diabetes 3.9
13

Chart 2–13 

Leading Causes of Death, Black Females, U.S., 2006

In 2006, among black females, heart disease and stroke were the first and third leading causes of death, 

respectively.36

Cause of Death Percent of All Deaths

Heart disease 25.5

Cancer 21.6

Stroke 6.8

Diabetes 5.0

Nephritis 3.2

Accidents 3.1

Chart 2–14 

Leading Causes of Death, Asian Males, U.S., 2006

In 2006, among Asian males, heart disease, stroke, and COPD and allied conditions were the second, third, and 

fifth leading causes of death, respectively.36

Cause of Death Percent of All Deaths

Cancer 25.6

Heart disease 24.9

Stroke 7.2

Accidents 5.6

COPD and allied conditions* 3.6

Diabetes 3.5

* Chronic lower respiratory diseases.

Chart 2–15 

Leading Causes of Death, Asian Females, U.S., 2006

In 2006, among Asian females, heart disease and stroke were the second and third leading causes of death, 

respectively.36

Cause of Death Percent of All Deaths

Cancer 27.2

Heart disease 22.7

Stroke 9.3

Accidents 3.8

Diabetes 3.8

Influenza/pneumonia 3.0
14

Chart 2–16 

Leading Causes of Death, Hispanic Males, U.S., 2006

In 2006, among Hispanic males, heart disease and stroke were the first and fourth leading causes of death, 

respectively.36

Cause of Death Percent of All Deaths

Heart disease 20.9

Cancer 18.7

Accidents 12.3

Stroke 4.4

Diabetes 4.2

Homicide 4.0

Chart 2–17 

Leading Causes of Death, Hispanic Females, U.S., 2006

In 2006, among Hispanic females, heart disease, stroke, and COPD and allied conditions were the first, third, and 

sixth leading causes of death, respectively.36 

Cause of Death Percent of All Deaths

Heart disease 22.8

Cancer 21.8

Stroke 6.4

Diabetes 5.4

Accidents 5.0

COPD and allied conditions* 2.7

* Chronic lower respiratory diseases.

Chart 2–18 

Leading Causes of Death, American Indian Males, U.S., 2006

In 2006, among American Indian males, heart disease was the leading cause of death.36 

Cause of Death Percent of All Deaths

Heart disease 20.1

Cancer 16.0

Accidents 15.5

Diabetes 4.7

Chronic liver disease 4.3

Suicide 4.0
15

Chart 2–19 

Leading Causes of Death, American Indian Females, U.S., 2006

In 2006, among American Indian females, heart disease, stroke, and COPD and allied conditions were the second, 

fifth, and sixth leading causes of death, respectively.36

Cause of Death Percent of All Deaths

Cancer 19.2

Heart disease 18.8

Accidents 8.1

Diabetes 7.0

Stroke 5.0

COPD and allied conditions* 4.3

* Chronic lower respiratory diseases.

Chart 2–20 

Prevalence of Leading Chronic Conditions Causing Limitation of Activity, U.S., 2007

In 2007, heart disease was the third leading chronic condition causing activity limitation. Hypertension, lung 

condition, and stroke were also very common.24

Chronic Condition

Prevalence

(Millions)

Arthritis 6.6

Back/neck conditions 6.6

Heart condition 4.3

Mental conditions 3.6

Diabetes 3.5

Hypertension 3.3

Musculoskeletal condition 3.2

Nervous condition 2.9

Lung condition 2.9

Fractures 2.7

Vision condition 2.0

Stroke 1.6

Cancer 1.5
16

Chart 2–21 

Age-Adjusted Percent of Population Currently Smoking by Race and Sex, Ages 18 and Older, U.S., 

1965–2007

From 1965 to 1990, the percent of the population aged 18 years and older who reported that they smoke cigarettes 

decreased significantly. Since then, the percent of the population who reported that they currently smoke declined 

modestly.37

Year

Black 

Male

White 

Male

Black 

Female

White 

Female

1965 58.8 50.4 31.8 33.9

1966 — — — —

1967 — — — —

1968 — — — —

1969 — — — —

1970 — — — —

1971 — — — —

1972 — — — —

1973 — — — —

1974 53.6 41.7 35.6 32.0

1975 — — — —

1976 — — — —

1977 — — — —

1978 — — — —

1979 43.9 36.4 30.5 30.3

1980 — — — —

1981 — — — —

1982 — — — —

1983 41.7 34.2 31.3 29.6

1984 — — — —

1985 40.2 31.3 30.9 27.9

1986 — — — —

1987 — — — —

1988 — — — —

1989 — — — —

1990 32.8 27.6 20.8 23.5

1991 — — — —

1992 33.3 27.7 24.5 25.3

1993 33.7 26.6 20.6 23.4

1994 34.3 27.1 21.6 24.0

1995 29.4 26.2 23.5 23.4

1996 — — — —

1997 32.4 26.8 22.5 22.8

1998 29.0 26.0 21.1 23.0

1999 28.4 25.0 20.5 22.5

2000 25.7 25.4 20.7 22.0

2001 27.6 24.8 18.0 22.0

2002 26.6 24.9 18.3 21.0

2003 25.3 23.8 17.9 20.1

2004 23.5 23.0 16.9 19.5

2005 25.9 23.3 17.1 19.1

2006 26.1 23.5 18.5 18.8

2007 23.4 22.2 15.6 18.5
17

Chart 2–22 

Age-Adjusted Percent of Population With High Serum Cholesterol* by Race and Sex, Ages 20–74, 

U.S., 1976–1980 to 2003–2006

From 1976–1980 to 1999–2002, the prevalence of high serum cholesterol declined for each sex and racial/ethnic 

group, continuing to 2003–2006 for black and white males and black females. This trend was reversed in white 

and Mexican-American females.17, 37

Year

White†

Male

White†

Female

Black†

Male

Black†

Female

Mexican-American 

Male

Mexican-American 

Female

1976–1980 26.4 29.6 25.5 26.3 20.3 20.5

1988–1994 18.7 20.7 16.4 19.9 18.7 17.7

1999–2002 17.0 17.4 12.5 16.6 17.6 12.7

2003–2006 16.0 17.9 11.2 13.0 17.7 13.8

* High serum cholesterol is 240 mg/dL.

†

 Non-Hispanic.

Chart 2–23 

Age-Adjusted Percent of Population That Is Overweight* by Race and Sex, Ages 20–74, U.S., 

1976–1980 to 2003–2006

From 1976–1980 to 2003–2006, the prevalence of overweight males and females increased for each racial/ethnic 

group.17, 37

Year

White†

Male

White†

Female

Black†

Male

Black†

Female

Mexican-American 

Male

Mexican-American 

Female

1976–1980 53.8 38.7 51.3 62.6 61.6 61.7

1988–1994 61.6 47.2 58.2 68.5 69.4 69.6

1999–2002 69.5 57.0 62.0 77.6 74.1 71.4

2003–2006 72.1 57.4 72.0 80.5 77.3 74.4

* Overweight (including obesity) is a body mass index of 25 kg/m2

. †

 Non-Hispanic.
18

Chart 2–24 

Projected Economic Cost of Cardiovascular, Lung, and Blood Diseases, U.S., 2010

In 2010, cardiovascular, lung, and blood diseases are projected to cost $445 billion in health care expenditures and 

$230 billion in lost productivity. Costs attributed to them as secondary causes of morbidity and mortality are not 

included.35, 38–44

Dollars (Billions)

Disease Total Direct Morbidity Mortality

Total CVD 485.6 324.1 39.1 122.4

Heart disease 311.1 189.5 24.0 97.6

Coronary 168.6 96.0 10.6 62.0

Heart failure 38.6 35.1 —* 3.5

Stroke 71.2 48.2 7.0 16.0

Hypertensive disease 73.9 54.7 8.4 10.8

Lung diseases 173.4 108.9 27.9 36.6

COPD 49.9 29.5 8.0 12.4

Asthma 20.7 15.6 3.1 2.0

Blood diseases 15.9 11.8 0.7 3.4

Anemias 9.6 8.0 0.6 1.0

* No estimate is available.

Chart 2–25 

Projected Direct Cost of Cardiovascular, Lung, and Blood Diseases, U.S., 2010

In 2010, hospital care is projected to be the largest type of direct cost for health care expenditures related to 

cardiovascular, lung, and blood diseases.38–44

Dollars (Billions)

Disease Total Hospital Care

Physicians 

Services*

Prescription 

Drugs

Home 

Heath Care

Nursing 

Home Care

Total CVD 324.1 150.1 46.4 52.3 16.8 48.2

Heart disease 189.5 106.3 23.8 22.1 7.4 23.4

Coronary 96.0 54.6 13.4 10.3 2.2 12.3

Heart failure 35.1 20.1 2.4 3.3 3.4 4.5

Stroke 48.2 21.0 3.8 1.3 5.0 17.1

Hypertensive disease 54.7 8.5 13.9 24.7 2.7 5.1

Lung diseases 108.9 68.2 15.9 16.1 3.6 5.2

COPD 29.5 13.2 5.5 5.8 1.3 3.7

Asthma 15.6 5.5 4.2 5.9 —† —†

Blood diseases 11.8 6.1 2.5 0.8 1.2 1.1

Anemias 8.0 3.9 1.7 0.6 0.8 1.0

* Physicians, clinics, and other professional services.

†

 No estimate is available.
19

3. Cardiovascular Diseases

The diagnostic group cardiovascular diseases is used here to mean diseases and congenital malformations of the 

circulatory system as coded in the ICD.

Charts 3–1 through 3–3 show the distribution of deaths in 2006 due to specific CVD, heart disease, and stroke 

deaths, respectively.35 For CVD, Chart 3–4 shows, according to ICD-9-CM codes, the number of physician office 

visits, the number of hospitalizations, and length of hospital stay in 2006 and according to ICD-10 codes, the 

number of deaths in 2006.34, 35, 44 Subsequent charts display morbidity and mortality for total CVD and selected 

subgroups.

Coronary Heart Disease

CHD includes acute myocardial infarction (AMI) and angina pectoris. In the Chart Book, charts provide information on the prevalence and hospitalization rates of AMI and angina pectoris. Mortality data are not shown for 

them individually because good diagnostic information is often not available at the time in which death certificates are completed.

Over the years multiple revisions of the ICD resulted in changes in diagnostic terms and codes included in the 

CHD category that compromised direct comparability of CHD deaths over time. For example, ICD-10 expanded 

CHD (over ICD-9) to include “Atherosclerotic CVD.” To maintain comparability over time, CHD death rates in 

ICD-9 (1979–1998) were retabulated to include deaths coded to the additional term. As a result, CHD death rates 

from 1979 to 1998 included in this Chart Book are higher than those found in issues of the Chart Book prior to 

2004.

Heart Failure

Heart failure is a sequela of various heart diseases. It is a heart “condition,” not a heart “disease,” and is more 

common as a contributing rather than an underlying cause of death. Thus, it is imprecise to classify heart failure 

as an underlying cause of death. The condition, however, is increasingly prevalent and common in the reporting 

of hospitalizations and mortality. In fact, hospitalizations and mortality for heart failure have increased (until very 

recently), while mortality for total heart diseases has declined substantially. Charts are presented for any mention 

of heart failure on death certificates and for heart failure nominally classified as the underlying cause.

Cardiomyopathy

In 2006, 24,703 deaths were attributed to cardiomyopathy, although no consensus exists on classification and 

diagnostic criteria for the disease. This limitation presumably has little effect on any mortality differences influenced by age, race, or sex.

Atrial Fibrillation and Other Heart Diseases

The number of hospitalizations for atrial fibrillation has been steadily increasing over the past several years. 

Charts 3–47 and 3–48 show the number and rates of hospitalizations for atrial fibrillation. Mortality due to atrial 

fibrillation is not shown because atrial fibrillation is not intrinsically a fatal condition, although it does predispose 

individuals to potentially fatal conditions such as stroke. Moreover, the inconsistency in which atrial fibrillation 

is mentioned on death certificates and the difficulty of determining whether it is truly the cause of death make it 

impossible to gather reliable data.
20

Diseases of pulmonary circulation, acute and subacute endocarditis, and cardiac dysrhythmias are additional heart 

diseases of interest. Because measures of their morbidity, and especially their mortality, are of uncertain quality, 

charts pertaining to them have not been included.

Cerebrovascular Diseases (Stroke)

Cerebrovascular disease (i.e., stroke) is the third leading cause of death. Only a small proportion of deaths from 

stroke can be classified as cerebral hemorrhage, occlusion, thrombosis, or embolism. Most are coded to illdefined forms of cerebrovascular diseases (Chart 3–3). Therefore, mortality for the entire category is presented in 

charts related to stroke.

Hypertensive Disease

Prevalence and trend data on awareness, treatment, and control of hypertension are important statistics associated 

with hypertension morbidity and have therefore been included in this chapter. Mortality statistics are not presented for hypertensive disease because it is not a distinct underlying cause of death. In fact, its presence on death 

certificates is often arbitrary, and its selection as the underlying cause of death is often characterized by a lack of 

good diagnostic information at the time of death.

Diseases of Arteries

The ICD term diseases of arteries is used to refer to peripheral vascular disease and includes a variety of atherosclerotic disorders; none of them specifically involve the heart or brain. Examples are aortic aneurysm, atherosclerosis of the extremities, arterial embolism and thrombosis, and generalized atherosclerosis. Mortality data are 

presented, but valid prevalence estimates are not available.

Congenital Malformations of the Circulatory System

The ICD term congenital malformations of the circulatory system includes the specific subgroup congenital heart 

disease. Because most deaths in the overall category occur in infants younger than 1 year of age, the preferred 

mortality tabulation is the infant mortality rate.
21

Chart 3–1 

Cardiovascular Disease Deaths, Percent by Subgroup, U.S., 2006

Cause of Death Percent

CHD 51.2

Stroke 16.5

Other CVD 14.5

Heart failure (underlying)* 7.3

Hypertensive diseases 6.8

Diseases of arteries 3.7

* Heart failure as an underlying cause or otherwise mentioned on the death certificate accounted for 23% (192,002) of total CVD deaths.

Total deaths = 831,272 (100%), including 3,531 due to congenital CVD defects.

Chart 3–2 

Heart Disease Deaths, Percent by Subgroup, U.S., 2006

Cause of Death Percent

Other CHD 44.8

AMI 22.3

Heart failure (underlying)* 9.5

Other 7.2

Rhythmic 6.1

Hypertensive 5.2

Cardiomyopathy 4.0

Rheumatic/congenital 1.0

* Heart failure as an underlying cause or otherwise mentioned on the death certificate accounted for almost 29% (182,337) of total heart 

disease deaths.

Total deaths = 634,490 (100%), including 2,854 from congenital heart defects.

Chart 3–3 

Stroke Deaths, Percent by Subgroup, U.S., 2006

Cause of Death Percent

Stroke, unspecified 52.9

Other hemorrhage 19.8

Other cerebrovascular 17.9

Cerebral infarction 5.1

Subarachnoid hemorrhage 4.3

Total deaths = 137,119 (100%).
22

Chart 3–4 

Number of Hospitalizations, Physician Office Visits,* and Deaths for Cardiovascular Diseases, 

U.S., 2006

     Hospitalizations            

Diagnostic Category ICD-9-CM Codes

First-Listed

Discharges

(1,000)

Length of

Stay 

(Days)

Physician Office

Visits (1,000) ICD-10 Codes Deaths

Total 390–404, 410–448, 

451–459, 745–747

6,211 4.5 72,559 I00–I99, Q20–Q28 831,272

Heart disease: 390–398, 402, 404, 

410–429

4,195 4.4 24,182 I00–I09, I11, I13, 

I20–I51

631,636

Rheumatic heart disease 390–398 54 7.7 270 I00–I09 3,257

Hypertensive heart disease 402, 404 87 6.0 453 I11, I13 32,706

Coronary heart disease: 410–414, 429.2 1,760 4.0 10,956 I20–I25 425,425

AMI 410 647 5.4 206 I21, I22 141,462

Angina pectoris, stable 413 41 2.1 757 I20.1–I20.9 179

Angina pectoris, unstable 411 86 2.5 201 I20.0 30

Atherosclerotic CVD 429.2 — — 98 I25.0 61,030

Other CHD 412, 414 986 3.2 9,695 Other I23–I25 222,724

Diseases of pulmonary circulation: 415–417 160 5.7 264 I26–I28 12,387

Pulmonary embolism 415.1 145 5.6 128 I26 6,924

Other 415.0, 415.2–417 15 6.7 136 I27–I28 5,463

Subacute bacterial endocarditis 421 13 11.7 — I33.0 1,175

Cardiomyopathy 425 43 3.8 691 I42 24,703

Atrial fibrillation and flutter 427.3 461 3.5 4,065 I48 11,438

Other arrythmic disorders Other 427 311 3.2 1,966 Other I43–I49 26,301

Heart failure: 428 1,106 5.1 2,681 I50 60,337

Congestive heart failure 428.0 1,002 5.1 2,605 I50.0 55,923

Left heart failure and unspecified 428.1–428.9 104 5.5 76 150–150.9 4,414

Other heart disease Other 420–429 200 5.6 2,836 Other I30–I51 33,907

Other hypertensive disease 401, 403 426 3.1 37,885 I10, I12 23,855

Cerebrovascular diseases (stroke) 430–438 885 4.9 2,005 I60–I69 137,119

Diseases of arteries: 440–448 282 5.6 1,477 I70–I78 31,136

Atherosclerosis 440 129 5.7 251 I70 8,652

Aortic aneurysm 441 57 6.5 253 I71 13,238

Other diseases of arteries 442–448 96 5.0 973 I72–I78 9,246

Deep vein thrombosis 451.1 10 4.5 — I80.2 2,328

Other and unspecified CVD Other 451–459 343 4.4 6,591 Other I80–I99 1,667

Congenital malformations of CV system: 745–747 70 9.6 419 Q20–Q28 3,531

Congenital heart disease 745, 746 41 8.4 356 Q20–Q24 2,854

Other congenital cardiovascular disease747 29 11.5 63 Q25–Q28 677

* Estimates of hospitalizations and physician office visits are subject to sampling variability. Estimates of hospitalizations below 50,000 have 

a relative standard error of >11%. Estimates of physician office visits below 588,000 have a relative standard error of >30%.
23

Chart 3–5 

Change in Age-Adjusted Death Rates, U.S., 1950–2006

The death rates for CHD increased almost 10% from 1950 to its peak in 1968; by 2006, it was 69% lower than it 

was in 1950. Stroke mortality, on the other hand, declined for most of those years and by 2006 was 76% lower 

than it was in 1950. By comparison, the death rate for non-CVD causes decreased only 15% since 1950.31, 32

 Percent Change

Year CHD Stroke* Non-CVD

1950 0.0 0.0 0.0

1951 -1.3 0.4 -2.0

1952 -1.9 -0.3 -4.5

1953 0.0 -0.8 -6.0

1954 -3.1 -4.0 -11.6

1955 0.1 -1.9 -11.8

1956 1.6 -1.8 -12.0

1957 4.1 1.2 -10.6

1958 4.3 1.3 -12.6

1959 3.7 -0.9 -14.1

1960 5.5 -1.6 -11.5

1961 3.7 -4.2 -14.8

1962 6.9 -3.7 -13.2

1963 8.8 -3.8 -10.5

1964 5.4 -7.6 -12.9

1965 6.1 -8.0 -12.2

1966 5.8 -7.5 -11.4

1967 3.3 -11.8 -13.0

1968 9.8 -10.1 -8.2

1969 6.9 -14.0 -7.4

1970 1.9 -18.3 -10.9

1971 2.0 -18.3 -8.4

1972 1.4 -18.5 -7.2

1973 -0.6 -19.7 -8.9

1974 -5.7 -24.3 -9.6

1975 -11.7 -31.7 -11.1

1976 -13.0 -35.0 -10.9

1977 -16.2 -38.9 -14.7

1978 -17.6 -42.6 -13.6

1979 -22.8 -43.6 -21.1

1980 -21.5 -44.1 -18.1

1981 -25.0 -48.0 -19.4

1982 -27.1 -51.1 -20.6

1983 -28.1 -52.8 -19.2

1984 -30.8 -54.3 -18.1

1985 -32.6 -55.6 -16.1

1986 -35.5 -57.5 -15.3

1987 -37.7 -58.4 -14.9

1988 -38.9 -59.0 -13.1

1989 -41.4 -61.1 -13.1

1990 -43.2 -62.0 -13.0

1991 -45.3 -63.4 -13.9

1992 -47.1 -64.3 -15.1

1993 -46.9 -63.6 -12.6

1994 -48.9 -63.6 -12.9

1995 -50.0 -63.3 -13.1

1996 -51.7 -63.7 -14.2

1997 -53.7 -64.5 -15.3

1998 -55.2 -65.5 -14.8

1999 -55.7 -65.8 -13.2

2000 -57.5 -66.4 -12.7

2001 -59.5 -68.0 -13.0

2002 -61.1 -68.8 -13.0

2003 -62.9 -70.4 -13.2

2004 -65.8 -72.3 -15.2

2005 -67.2 -74.2 -14.0

2006 -69.3 -75.9 -14.9

* The comparability ratio 1.0502 was applied to the death rates reported in vital statistics for 1979–1998.
24

Chart 3–6 

Age-Adjusted Death Rates and Percent Change for All Causes and Cardiovascular Diseases, 

U.S., 1968 and 2006

From 1968 to 2006, the death rate for CVD declined 65%, compared with a 5.7% decline in the rate for all nonCVD causes. Mortality for CHD and stroke declined 72% and 73%, respectively.

31, 32

 Deaths/100,000 Pop. 

Cause of

Death

1968 2006 1968–2006

Difference

Percent

Change

All causes 1,304.5 776.5 -528.0 -40.5

CVD* 759.5 262.5 -497.0 -65.4

CHD 482.6 134.9 -347.7 -72.0

Stroke 162.5 43.6 -118.9 -73.2

Other CVD 114.4 84.0 -30.4 -26.6

Non-CVD 545.0 514.0 -31.0 -5.7

* Excludes congenital malformations of the circulatory system.

Chart 3–7 

Average Annual Percent Change in Age-Adjusted Death Rates for All Causes and Cardiovascular 

Diseases, U.S., 1968–2006

From 1968 to 2006, the death rate for total CVD had declined. The 1999–2006 average annual percent declines in 

the age-adjusted death rates were 4.0% for CVD, 5.1% for CHD, and 4.9% for stroke.31, 32 

Years

All 

Causes

Total 

CVD* CHD Stroke

Other 

CVD

All Other 

Causes

1968–1978 -2.2 -3.6 -2.9 -4.2 -6.7 -0.7

1979–1989 -0.6 -2.2 -2.9 -3.7 0.9 1.0

1989–1998 -0.9 -1.8 -2.8 -0.9 -0.1 -0.1

1999–2006 -1.7 -4.0 -5.1 -4.9 -1.6 -0.4

* Excludes congenital malformations of the circulatory system.

Chart 3–8 

Average Annual Percent Change in Age-Adjusted Death Rates for All Causes and Cardiovascular 

Diseases by Race and Sex, U.S., 1999–2006

From 1999 to 2006, average annual percent declines in mortality for CVD, CHD, and stroke within sex groups 

were greater in whites than in blacks. Within racial groups, the decline in CHD mortality was greater in females 

than in males. The decline in stroke mortality in whites was greater in males than in females.36

Cause 

of Death

All

Causes

Black 

Male

White 

Male

Black 

Female

White 

Female

All causes -1.7 -2.3 -2.0 -1.9 -1.5

CVD* -4.0 -3.4 -4.2 -3.8 -4.1

Heart disease -4.0 -3.4 -4.0 -4.0 -4.1

CHD -5.1 -4.4 -5.0 -5.2 -5.4

Stroke -4.9 -4.2 -5.4 -4.2 -4.9

Non-CVD -0.4 -1.7 -0.6 -0.7 0.1

* Excludes congenital malformations of the circulatory system.
25

Chart 3–9 

Deaths and Age-Adjusted Death Rates for Cardiovascular Diseases, U.S., 1979–2006

Although age-adjusted death rates for CVD declined considerably between 1979 and 2006, the total number of 

CVD deaths declined only modestly because of a growing and aging population.31, 32

Year

Deaths in 

Thousands

Deaths/100,000 

Population

1979 963 535.8

1980 993 543.7

1981 978 519.7

1982 972 505.0

1983 986 501.5

1984 978 487.5

1985 983 480.6

1986 973 466.4

1987 968 455.3

1988 974 450.4

1989 936 425.0

1990 920 412.5

1991 920 400.0

1992 918 389.6

1993 952 395.3

1994 945 384.3

1995 956 380.5

1996 954 372.1

1997 948 362.4

1998 945 353.8

1999 954 350.8

2000 942 341.4

2001 927 328.2

2002 923 319.0

2003 907 307.7

2004 866 288.0

2005 861 278.8

2006 828 262.5

Chart 3–10 

Percent of All Deaths Due to Cardiovascular Diseases* by Age, U.S., 2006

In 2006, the percent of deaths due to CVD increased with age among adults: 19% for those aged 35-44 years and 

45% for those aged 85 years and older.31

Age (Years) Percent of All Deaths

<1 7.6

1–4 8.8

5–14 7.9

15–24 4.7

25–34 10.3

35–44 19.2

45–54 25.9

55–64 28.9

65–74 30.7

75–84 36.3

85 44.9

* Includes congenital malformations of the circulatory system.
26

Chart 3–11 

Age-Adjusted Death Rates for Cardiovascular Diseases* by State, U.S., 2003–2005

In 2003–2005, CVD mortality was generally highest in the Southeastern United States.15

Rank State Deaths/100,000 Population

1 Mississippi 378.7

2 Oklahoma 362.6

3 Alabama 358.4

4 Tennessee 346.0

5 West Virginia 346.0

6 Louisiana 341.9

7 Kentucky 336.0

8 Arkansas 332.6

9 Missouri 321.0

10 Michigan 319.4

11 Georgia 319.2

12 Nevada 313.3

13 Ohio 313.1

14 Indiana 311.0

15 South Carolina 309.5

16 New York 305.5

17 Pennsylvania 301.6

18 North Carolina 300.2

19 Delaware 298.9

20 Illinois 296.3

21 Texas 296.2

22 Maryland 294.6

23 Virginia 284.6

24 Rhode Island 284.1

25 New Jersey 282.3

26 California 282.2

27 Kansas 277.3

28 Iowa 271.4

29 Wisconsin 267.8

30 Idaho 260.8

31 South Dakota 260.2

32 New Hampshire 259.8

33 Maine 259.1

34 Oregon 259.0

35 Nebraska 258.5

36 Florida 258.1

37 Washington 257.6

38 North Dakota 257.6

39 Wyoming 257.0

40 Connecticut 252.7

41 Vermont 249.6

42 Massachusetts 247.9

43 Montana 246.8

44 Arizona 244.4

45 Alaska 243.7

46 New Mexico 242.2

47 Colorado 241.3

48 Utah 237.0

49 Hawaii 235.8

50 Minnesota 214.1

* Excludes congenital malformations of the circulatory system.
27

Chart 3–12 

Percent Decline in Age-Adjusted Death Rates for Cardiovascular Diseases* by State, U.S.,

1993–1995 to 2003–2005

From 1993–1995 to 2003–2005, the smallest percent declines in death rates for CVD tended to be in the 

Southeastern United States.15

Rank State Percent Decline

1 Minnesota -33.0

2 Vermont -32.6

3 Nebraska -29.2

4 New Hampshire -28.6

5 Connecticut -28.3

6 New York -28.0

7 South Carolina -27.9

8 Maine -27.9

9 Illinois -27.4

10 Virginia -27.3

11 Alaska -27.2

12 Massachusetts -26.9

13 South Dakota -26.6

14 Wisconsin -26.5

15 North Dakota -26.4

16 Arizona -26.3

17 Florida -25.6

18 North Carolina -25.3

19 Indiana -25.3

20 Iowa -25.1

21 New Jersey -24.9

22 Pennsylvania -24.9

23 Montana -24.7

24 Wyoming -24.4

25 Oregon -24.1

26 Washington -24.0

27 Georgia -23.9

28 Michigan -23.7

29 Kansas -23.6

30 Ohio -23.3

31 Colorado -23.3

32 California -23.2

33 Hawaii -23.0

34 Missouri -22.9

35 Texas -22.8

36 New Mexico -22.7

37 Utah -22.6

38 Idaho -22.3

39 Kentucky -21.9

40 Rhode Island -21.7

41 Delaware -21.6

42 Mississippi -21.2

43 Maryland -21.1

44 West Virginia -21.0

45 Arkansas -20.9

46 Nevada -20.4

47 Louisiana -20.3

48 Tennessee -20.3

49 Oklahoma -15.4

50 Alabama -14.2

* Excludes congenital malformations of the circulatory system.
28

Chart 3–13 

Age-Adjusted Death Rates for Heart Disease by Race/Ethnicity and Sex, U.S., 2006

In 2006, heart disease mortality was 53% higher in males than in females. Within sex groups, it was highest in 

non-Hispanic blacks and lowest in Asians.36

 Deaths/100,000 Population

Race/Ethnicity Male Female

Total 248.5 162.2

Black* 326.5 216.2

White* 250.0 160.9

American Indian 170.1 113.2

Hispanic 175.2 118.9

Asian 136.2 87.3

* Non-Hispanic.

Chart 3–14 

Death Rates for Heart Disease in Males by Age and Race/Ethnicity, U.S., 2006

In 2006, heart disease mortality in males was highest in non-Hispanic blacks across all age groups. This disparity 

was proportionately greater in younger age groups than in older age groups.36

 Deaths/100,000 Population

Age 

(Years) Black* White* Hispanic

American

Indian Asian

45–54 235.0 124.5 75.6 119.5 55.7

55–64 537.9 284.5 202.3 256.2 145.4

65–74 1,062.7 644.3 505.6 573.6 344.3

75–84 2,164.2 1,767.4 1,308.4 1,176.6 963.3

* Non-Hispanic.

Chart 3–15 

Death Rates for Heart Disease in Females by Age and Race/Ethnicity, U.S., 2006

In 2006, the disparity in heart disease mortality between blacks and other racial and ethnic groups was as great or 

greater for females than for males (also see Chart 3–14).36

 Deaths/100,000 Population

Age 

(Years) Black* White*

American

Indian Hispanic Asian

45–54 114.4 42.2 41.8 27.3 15.9

55–64 257.7 113.2 125.2 86.9 48.4

65–74 588.6 329.1 322.5 273.0 187.4

75–84 1,483.2 1,135.8 937.9 894.5 639.8

* Non-Hispanic.
29

Chart 3–16 

Age-Adjusted Prevalence of Acute Myocardial Infarction by Race and Sex, Ages 25–74, 

U.S., 1971–1975 to 2003–2006

From 1971–1975 to 1999–2002, the prevalence of AMI mostly declined in whites, males, and females. In 

2003–2006, the downward trend continued in males, but was reversed in whites and females. The prevalence of 

AMI rose in blacks from 1976–1980 to 1988–1994 but then declined through 2003–2006.17

 Percent of Population

Years Black White Male Female

1971–1975 2.64 3.81 5.06 2.51

1976–1980 2.48 3.38 4.69 1.97

1988–1994 3.49 3.17 4.81 1.84

1999–2002 3.02 2.98 4.25 1.63

2003–2006 2.81 3.26 4.08 2.28

Chart 3–17 

Prevalence of Acute Myocardial Infarction by Age and Sex, U.S., 1999–2006

In 1999–2006, the prevalence of AMI was higher in males than in females and increased substantially with age.17

 Percent of Population

Age (Years) Male Female

35–44 1.04 0.47

45–54 3.25 1.92

55–64 9.62 3.73

65–74 14.59 6.57

75 19.40 10.41

Chart 3–18 

Prevalence of Acute Myocardial Infarction by Age and Race, U.S., 1999–2006

In 1999–2006, the prevalence of AMI was higher in blacks than in whites aged 35 to 64 years, but was higher in 

whites than in blacks among those aged 65 years and older.17

 Percent of Population

Age (Years) Black White

35–44 1.36 0.78

45–54 2.77 2.68

55–64 6.92 6.49

65–74 7.81 10.84

75 14.06 14.62
30

Chart 3–19 

Prevalence of Angina Pectoris by Age and Sex, U.S., 1999–2006

In 1999–2006, the prevalence of angina pectoris, which increased substantially with age, was slightly higher in 

females than in males aged 35 to 64 years, but was higher in males than in females among those aged 65 years 

and older.17

 Percent of Population

Age (Years) Male Female

35–44 1.8 2.2

45–54 5.0 5.3

55–64 6.9 7.4

65–74 13.4 10.6

75 14.3 13.5

Chart 3–20 

Prevalence of Angina Pectoris by Age and Race, U.S., 1999–2006

In 1999–2006, the prevalence of angina pectoris increased with age for blacks and whites. The increase, however, 

did not continue in blacks past age 74 years. Prevalence was higher in blacks than in whites prior to age 65 years 

but was higher in whites than in blacks for those aged 65 years and older.17

 Percent of Population

Age (Years) Black White

35–44 3.4 1.8

45–54 6.5 5.0

55–64 9.5 6.8

65–74 10.9 11.8

75 9.2 14.8
31

Chart 3–21 

Hospitalization Rates for Acute Myocardial Infarction, Ages 45–64 and 65 and Older, 

U.S., 1965–2006

For those aged 45–64 years, hospitalization rates for AMI increased from 1965 to the mid-1970s and then 

remained stable before declining in the mid-1990s. For those aged 65 years and older, hospitalization rates for 

AMI increased from 1965 to 1986; the rates began to decline in the early 2000s through 2006.33, 34

 Hospitalizations/10,000 Population

Year Ages 45–64 Years Ages 65 Years

1965 42.9 98.5

1966 43.3 99.3

1967 45.5 93.5

1968 43.9 99.3

1969 48.4 110.6

1970 53.0 122.0

1971 52.4 119.5

1972 57.6 136.5

1973 53.9 132.0

1974 57.8 137.8

1975 63.9 131.1

1976 63.1 137.6

1977 61.9 136.5

1978 62.5 141.8

1979 56.7 122.4

1980 51.7 129.4

1981 57.9 141.6

1982 57.9 141.5

1983 56.4 139.6

1984 57.5 142.9

1985 59.5 152.7

1986 58.4 155.0

1987 61.5 145.0

1988 52.4 141.6

1989 52.3 143.3

1990 49.6 126.9

1991 48.8 133.5

1992 55.4 137.3

1993 50.5 136.0

1994 51.0 136.7

1995 49.1 140.5

1996 52.2 147.7

1997 47.1 133.5

1998 41.9 146.7

1999 46.4 148.6

2000 39.6 143.2

2001 40.0 140.0

2002 38.9 140.8

2003 33.0 138.2

2004 32.5 126.6

2005 29.5 116.9

2006 29.1 105.7
32

Chart 3–22 

Hospital Case-Fatality Rates for Acute Myocardial Infarction, Ages Younger Than 65 and 65 and 

Older, U.S., 1970–2006

From 1970 to 2006, hospital case-fatality rates for AMI declined substantially for those younger than 65 years and 

for those aged 65 years and older.33, 34

 Percent Discharged Dead

Year Ages <65 Years Ages 65 Years

1970 16.0 37.8

1971 14.0 33.0

1972 11.9 32.6

1973 12.7 31.5

1974 10.3 29.6

1975 11.9 28.4

1976 12.1 25.7

1977 10.2 25.9

1978 9.7 28.2

1979 8.5 29.3

1980 8.4 26.6

1981 7.1 23.3

1982 10.0 27.6

1983 8.2 26.4

1984 7.7 22.4

1985 6.9 21.8

1986 7.6 21.0

1987 5.9 19.8

1988 7.4 18.0

1989 4.8 17.2

1990 5.0 17.6

1991 5.9 16.4

1992 3.8 15.7

1993 4.7 13.7

1994 3.8 14.3

1995 3.9 14.0

1996 4.5 14.7

1997 3.7 12.9

1998 3.8 13.6

1999 4.4 12.7

2000 5.8 12.5

2001 4.7 13.2

2002 3.1 11.4

2003 3.0 9.9

2004 2.6 12.2

2005 2.9 10.9

2006 2.1 9.8
33

Chart 3–23 

Age-Adjusted Death Rates for Coronary Heart Disease, Actual and Expected, U.S., 1950–2006

CHD accounted for 425,000 deaths in 2006. It would have accounted for 1,511,000 deaths if CHD mortality had 

remained at its 1968 peak.31, 32 Peak minus actual rates results in 1,086,000 fewer deaths in 2006 than expected— 

Actual: 425,000; Expected: 1,511,000.

 Deaths/100,000 Population

Year Actual Rate

Rate if Rise 

Continued Peak Rate

1950 439.5 — —

1951 433.6 — —

1952 431.2 — —

1953 439.5 — —

1954 426.0 — —

1955 440.1 — —

1956 446.7 — —

1957 457.6 — —

1958 458.2 — —

1959 455.8 — —

1960 463.8 — —

1961 455.9 — —

1962 469.7 — —

1963 478.4 — —

1964 463.2 — —

1965 466.4 — —

1966 465.1 — —

1967 453.9 — —

1968 482.6 — 482.6

1969 469.8 — 482.6

1970 448.0 480.9 482.6

1971 448.5 483.4 482.6

1972 445.5 486.0 482.6

1973 437.0 488.5 482.6

1974 414.6 491.1 482.6

1975 388.1 493.7 482.6

1976 382.2 496.3 482.6

1977 368.5 498.9 482.6

1978 362.0 501.5 482.6

1979 339.1 504.2 482.6

1980 345.2 506.9 482.6

1981 329.5 509.5 482.6

1982 320.4 512.2 482.6

1983 316.1 514.9 482.6

1984 304.1 517.6 482.6

1985 296.2 520.4 482.6

1986 283.4 523.1 482.6

1987 273.9 525.9 482.6

1988 268.5 528.7 482.6

1989 257.5 531.4 482.6

1990 249.6 534.2 482.6

1991 240.6 537.1 482.6

1992 232.6 539.9 482.6

1993 233.2 542.8 482.6

1994 224.5 545.6 482.6

1995 219.7 548.5 482.6

1996 212.1 551.4 482.6

1997 203.6 554.3 482.6

1998 197.1 557.2 482.6

1999 194.6 560.2 482.6

2000 186.8 563.1 482.6

2001 177.8 566.1 482.6

2002 170.8 569.1 482.6

2003 162.9 572.1 482.6

2004 150.5 575.1 482.6

2005 144.4 578.1 482.6

2006 134.9 581.2 482.6
34

Chart 3–24 

Age-Adjusted Death Rates for Coronary Heart Disease by Race/Ethnicity and Sex,

U.S., 1999–2006

From 1999 to 2006, CHD mortality declined in non-Hispanic whites, non-Hispanic blacks, Hispanics, Asians, and 

American Indians, both male and female.36

 Male (Deaths/100,000 Population)

Year Black* White* American Indian Hispanic Asian

1999 260.3 253.0 184.3 200.1 154.1

2000 271.9 243.5 168.1 190.2 143.9

2001 264.4 230.2 147.1 185.8 130.1

2002 253.2 222.7 148.6 172.2 127.7

2003 246.1 212.4 152.3 158.0 119.3

2004 226.7 196.8 136.1 149.6 107.1

2005 216.3 190.2 121.5 148.4 105.2

2006 209.8 179.3 122.4 132.8 101.3

 Female (Deaths/100,000 Population)

Year Black* White* American Indian Hispanic Asian

1999 189.7 150.8 112.1 133.1 89.3

2000 185.0 144.3 99.1 125.1 83.7

2001 178.4 137.7 88.0 122.6 82.1

2002 171.4 131.7 87.1 112.2 76.9

2003 162.7 125.7 84.8 107.4 72.5

2004 150.5 115.5 82.4 95.3 66.7

2005 142.8 110.7 75.2 94.2 62.6

2006 132.0 102.4 76.4 85.4 58.9

* Non-Hispanic.
35

Chart 3–25 

Age-Adjusted Death Rates for Coronary Heart Disease by Race and Sex, U.S., 1950–2006

In the 1950s and 1960s, death rates for CHD increased in white males and in blacks, both male and female, but 

were relatively stable in white females. Since then, all rates have declined appreciably.31, 32

 Deaths/100,000 Population

Year

Black*

Male

White 

Male

Black*

Female

White

Female

1950 365.2 558.6 276.7 346.0

1951 365.7 555.9 269.0 338.0

1952 365.6 553.4 271.5 338.3

1953 386.8 558.2 278.2 342.3

1954 362.1 555.4 263.0 331.0

1955 372.9 568.7 274.0 343.4

1956 388.3 575.4 286.0 347.5

1957 410.8 589.0 297.8 355.8

1958 409.9 592.4 292.3 356.7

1959 407.1 590.7 284.1 355.0

1960 388.8 605.6 292.3 356.5

1961 420.5 598.2 305.2 348.0

1962 444.2 610.4 313.6 354.4

1963 461.9 624.5 318.5 359.8

1964 442.1 611.1 312.8 353.4

1965 419.3 613.9 303.0 358.6

1966 460.6 619.4 314.0 352.9

1967 441.8 608.4 301.3 343.7

1968 556.8 632.4 399.3 367.7

1969 539.5 619.5 381.3 357.2

1970 517.2 592.5 368.0 340.0

1971 511.2 596.7 357.3 340.0

1972 515.9 592.1 352.9 338.4

1973 510.4 584.4 355.5 329.8

1974 485.2 555.4 329.9 313.6

1975 452.7 525.5 304.5 291.2

1976 446.6 517.6 298.3 287.8

1977 441.6 500.2 296.2 275.9

1978 433.1 489.3 287.7 272.9

1979 397.3 462.1 255.8 255.4

1980 418.7 466.3 274.2 262.6

1981 395.6 447.5 258.2 250.2

1982 383.1 435.0 249.8 243.7

1983 383.3 427.3 254.5 241.1

1984 370.4 410.1 244.4 232.9

1985 367.7 399.3 241.2 226.4

1986 358.9 377.8 238.7 218.0

1987 352.6 363.4 232.3 211.5

1988 348.3 355.7 232.4 207.6

1989 345.6 339.5 228.6 198.5

1990 336.9 330.5 220.1 192.1

1991 331.7 317.6 216.9 184.7

1992 319.0 307.6 208.8 178.2

1993 324.6 306.8 215.3 178.9

1994 308.5 295.3 203.9 172.7

1995 308.7 287.3 201.8 169.3

1996 290.7 278.3 195.2 163.4

1997 283.8 266.5 187.6 156.6

1998 277.2 256.7 183.3 152.0

1999 282.0 251.2 188.0 150.5

2000 269.5 241.6 183.2 143.9

2001 262.0 228.4 176.7 137.4

2002 250.6 220.5 169.7 131.2

2003 243.3 209.6 160.9 125.0

2004 223.9 194.2 148.7 114.7

2005 213.9 187.7 140.9 110.0

2006 206.4 176.3 130.0 101.5

* Nonwhite from 1950 to 1967.
36

Chart 3–26 

Deaths and Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1980–2006

Since 1980, the number of deaths and the age-adjusted death rates for CHD decreased almost every year.31, 32

Year Deaths in Thousands

Deaths/100,000 

Population

1980 636 345.2

1981 624 329.5

1982 621 320.3

1983 625 316.1

1984 613 304.1

1985 608 296.2

1986 593 283.4

1987 584 273.9

1988 582 268.5

1989 569 257.5

1990 558 249.6

1991 555 240.6

1992 549 232.6

1993 563 233.2

1994 553 224.5

1995 552 219.7

1996 545 212.1

1997 533 203.6

1998 527 197.1

1999 530 194.6

2000 514 186.8

2001 502 177.8

2002 494 170.8

2003 480 162.9

2004 451 150.2

2005 446 144.4

2006 425 134.8
37

Chart 3–27 

Average Annual Percent Change in Age-Adjusted Death Rates for Coronary Heart Disease by 

Race and Sex, U.S., 1950–2006

The average annual decline in CHD mortality began during the 1968–1978 period for all groups (slightly earlier 

for white females) and was greatest—5% overall—during the 1999–2006 period. Since 1979, within 

sex groups, CHD mortality declined more for whites than blacks.31, 32

Years

Total 

Population

Black*

Male

White

Male

Black*

Female

White

Female

1950–1957 0.6 1.3 0.7 0.9 0.4

1958–1967 0.1 1.3 0.4 0.8 -0.2

1968–1978 -2.9 -2.5 -2.6 -3.3 -3.1

1979–1989 -2.9 -1.8 -3.2 -1.5 -2.7

1989–1998 -2.8 -2.4 -3.0 -2.3 -2.7

1999–2006 -5.1 -4.4 -5.0 -5.2 -5.4

* Nonwhite from 1950 to 1967.

Chart 3–28 

Average Annual Percent Change in Death Rates for Coronary Heart Disease by Age, Race, and 

Sex, U.S., 1999–2006

From 1999 to 2006, the average annual percent decline in CHD mortality was greater for those aged 55 years and 

older than for those aged 54 years and younger. White females aged 35–44 years experienced an increase in CHD 

mortality during this period.36

Age 

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

35–44 -3.0 -1.2 -2.1 1.0

45–54 -2.0 -2.5 -2.9 -1.3

55–64 -4.1 -4.5 -4.8 -5.3

65–74 -4.8 -5.9 -6.1 -5.7

75–84 -3.7 -4.8 -4.8 -5.1

85 -6.0 -5.1 -4.5 -5.4
38

Chart 3–29 

Age-Adjusted Death Rates for Coronary Heart Disease by Race/Ethnicity and Sex, U.S., 2006

In 2006, CHD mortality was 70% higher in males than in females. Within sex groups, it was highest in nonHispanic blacks and lowest in Asians.36

 Deaths/100,000 Population

Race/Ethnicity Male Female

Total 176.5 103.1

Black* 209.8 132.0

White* 179.3 102.4

American Indian 122.4 76.4

Hispanic 132.8 85.4

Asian 101.3 58.9

* Non-Hispanic.

Chart 3–30 

Death Rates for Coronary Heart Disease in Males by Age and Race/Ethnicity, U.S., 2006

In 2006, CHD mortality in males increased with age from 45–54 to 75–84 years for non-Hispanic blacks, nonHispanic whites, Hispanics, American Indians, and Asians. The relatively high rates in non-Hispanic blacks and 

low rates in Asians occurs in all age groups.36

 Deaths/100,000 Population

Age 

(Years) Black* White*

American

Indian Hispanic Asian

45–54 133.8 90.2 81.0 52.7 39.9

55–64 347.2 216.7 191.7 156.5 114.0

65–74 717.2 488.6 424.4 394.1 261.7

75–84 1,476.8 1,288.8 900.6 1,022.8 736.4

* Non-Hispanic.

Chart 3–31 

Death Rates for Coronary Heart Disease in Females by Age and Race/Ethnicity, U.S., 2006

In 2006, CHD mortality in females increased with age from 45–54 to 75–84 years for non-Hispanic blacks, nonHispanic whites, Hispanics, American Indians, and Asians. The relatively high rates in non-Hispanic blacks and 

low rates in Asians occurs in all age groups.36

 Deaths/100,000 Population

Age 

(Years) Black* White*

American

Indian Hispanic Asian

45–54 57.7 25.1 21.8 15.5 8.7

55–64 151.4 74.6 85.5 60.9 31.9

65–74 373.4 221.9 234.9 199.2 132.2

75–84 954.0 742.7 654.1 666.6 448.6

* Non-Hispanic.
39

Chart 3–32 

Age-Adjusted Death Rates for Coronary Heart Disease by State, U.S., 2003–2005

In 2003–2005, a narrow band of states from New York through Appalachia to Oklahoma had high CHD death 

rates. Many Western Mountain states had low CHD death rates.15

Rank State Deaths/100,000 Population

1 Oklahoma 204.9

2 New York 202.0

3 Rhode Island 189.3

4 Tennessee 188.2

5 West Virginia 182.2

6 Arkansas 172.9

7 Michigan 172.8

8 Missouri 168.2

9 Delaware 167.0

10 Ohio 166.5

11 Kentucky 166.4

12 Mississippi 164.7

13 New Jersey 161.3

14 Louisiana 160.4

15 Maryland 159.6

16 Pennsylvania 156.8

17 California 154.2

18 Texas 153.8

19 Iowa 153.1

20 Illinois 152.6

21 Indiana 152.3

22 Florida 149.2

23 South Dakota 145.9

24 North Carolina 145.1

25 New Hampshire 143.5

26 North Dakota 141.6

27 Arizona 138.4

28 South Carolina 137.3

29 Vermont 133.0

30 Alabama 131.7

31 Washington 131.3

32 Wisconsin 129.3

33 Virginia 129.2

34 Nevada 129.1

35 Connecticut 128.4

36 Maine 128.4

37 Kansas 126.7

38 Georgia 126.6

39 New Mexico 126.6

40 Idaho 123.9

41 Wyoming 121.8

42 Massachusetts 119.3

43 Oregon 111.3

44 Colorado 111.1

45 Nebraska 107.4

46 Montana 107.2

47 Alaska 101.3

48 Hawaii 92.0

49 Minnesota 91.9

50 Utah 90.1
40

Chart 3–33 

Age-Adjusted Death Rates* for Coronary Heart Disease by Country and Sex, Ages 35–74, 2007

In 2006–2007, among 16 industrialized countries, the United States ranked sixth highest for CHD mortality in 

males and fourth highest in females.45

 Deaths/100,000 Population

Country Male Female

Romania 287.6 117.4

Czech Republic 223.9 78.4

Poland (2006)† 198.5 57.5

Scotland 195.3 67.5

Finland 180.1 41.2

United States of America (2006)† 162.2 65.1

England and Wales 138.3 43.4

Germany (2006)† 125.2 38.2

Sweden (2006)† 118.7 39.1

Norway (2006)† 97.1 32.3

Denmark (2006)† 84.8 32.4

Italy (2006)† 80.1 23.1

Netherlands 71.7 25.3

France (2006)† 58.4 13.0

Republic of Korea (2006)† 51.4 20.0

Japan 47.7 14.2

* Age adjusted to European standard.

†

 Data for 2006.

Chart 3–34 

Change in Age-Adjusted Death Rates* for Coronary Heart Disease in Males by Country, Ages 

35–74, 1999–2007†

From 1999 to 2007, when compared with the United States, 8 of the 13 countries shown had a steeper average 

annual decline in CHD mortality in males.45

Country

Average Annual

Percent Change‡

Denmark (1999–2006) -8.8

Netherlands (1999–2007) -8.8

Norway (1999–2006) -8.4

England and Wales (2001–2007) -7.0

Germany (1999–2006) -5.7

Poland (1999–2006) -5.5

Finland (1999–2007) -5.3

France (2000–2006) -5.2

United States of America (1999–2006) -4.7

Czech Repulblic (1999–2007) -4.6

Romania (1999–2007) -2.4

Japan (1999–2007) -1.7

Republic of Korea (1999–2006) -1.1

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.
41

Chart 3–35 

Change in Age-Adjusted Death Rates* for Coronary Heart Disease in Females by Country, 

Ages 35–74, 1999–2007 †

From 1999 to 2007, when compared with the United States, 9 of the 13 countries shown had a steeper average 

annual decline in CHD mortality in females.45

Country

Average Annual 

Percent Change ‡

Norway (1999–2006) -9.7

Denmark (1999–2006) -9.0

Netherlands (1999–2007) -9.0

England and Wales (2001–2007) -8.6

Germany (1999–2006) -7.2

Finland (1999–2007) -7.0

Poland (1999–2006) -6.5

France (2000–2006) -5.9

Czech Repulblic (1999–2007) -5.2

United States of America (1999–2006) -5.0

Romania (1999–2007) -4.0

Japan (1999–2007) -3.2

Republic of Korea (1999–2006) -1.7

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.

Chart 3–36 

Age-Adjusted Prevalence of Heart Failure by Race and Sex, Ages 25–74, U.S., 1971–1975 to 

2003–2006

From 1976–1980 to 1988–1994, the prevalence of HF increased markedly in males, females, whites, and 

blacks and remained relatively high thereafter. The extent to which the increase is attributed to the change in 

terminology, from HF to congestive HF, beginning with the 1988–1994 survey is unknown.17

 Percent of Population

Years Black White Male Female

1971–1975 1.5 1.0 1.1 1.1

1976–1980 1.1 0.9 1.2 0.8

1988–1994 3.0 1.8 2.3 1.7

1999–2002 2.6 1.5 2.1 1.2

2003–2006 3.1 1.9 2.6 1.5
42

Chart 3–37 

Hospitalization Rates for Congestive Heart Failure, Ages Younger Than 65 and 65 and Older, 

U.S., 1971–2006

Hospitalization rates for congestive HF in those younger than 65 years increased from 1971 to 1993 and remained 

stable through 2006. Rates for those 65 years and older increased from 1970 to 1998 and remained somewhat 

stable until 2006.33, 34

 Hospitalizations/10,000 Population

Year Ages <65 Years Ages 65 Years

1971 9.5 60.1

1972 11.3 73.3

1973 12.0 78.2

1974 12.8 82.7

1975 13.2 88.3

1976 13.7 97.3

1977 14.2 106.4

1978 14.9 112.5

1979 15.5 127.7

1980 14.3 133.5

1981 15.6 130.8

1982 16.2 132.6

1983 20.1 132.7

1984 20.6 151.7

1985 21.4 156.3

1986 23.1 158.2

1987 22.7 161.8

1988 24.4 175.5

1989 25.6 168.5

1990 26.0 182.0

1991 27.0 193.6

1992 31.5 206.4

1993 34.1 207.6

1994 29.8 210.0

1995 27.2 208.0

1996 28.5 202.7

1997 31.3 223.2

1998 30.6 226.7

1999 29.4 221.1

2000 31.9 220.2

2001 31.2 216.8

2002 32.8 201.4

2003 36.6 222.0

2004 33.0 225.0

2005 32.5 218.5

2006 32.9 216.6
43

Chart 3–38 

Hospital Case-Fatality Rates for Congestive Heart Failure, Ages Younger Than 65 and 65 and 

Older, U.S., 1982–2006

Hospital case-fatality rates for congestive HF declined appreciably from 1982 to 2006 for those younger than 65 

years and 65 years and older.33, 34

 Percent Discharged Dead

Year Ages <65 Years Ages 65 Years

1982 4.5 10.5

1983 5.9 10.7

1984 5.2 9.8

1985 4.5 9.0

1986 3.7 9.9

1987 4.6 7.9

1988 5.4 9.3

1989 4.1 7.6

1990 4.0 8.1

1991 3.9 8.9

1992 2.7 8.0

1993 2.6 7.2

1994 2.2 7.1

1995 3.4 5.0

1996 3.3 5.4

1997 1.6 5.6

1998 2.3 4.8

1999 1.3 6.0

2000 1.5 5.0

2001 2.4 4.6

2002 1.1 4.4

2003 3.0 5.0

2004 2.0 4.3

2005 1.7 3.6

2006 1.6 3.4
44

Chart 3–39 

Age-Adjusted Death Rates for Heart Failure as the Underlying Cause by Race and Sex, U.S., 

1981–2006

From 1981 to 1988, death rates with HF as the underlying cause increased in blacks and whites, both male and 

female. Rates stabilized in the early 1990s and remained so through 2006. Mortality was highest in black males 

and lowest in white females.36

 Deaths/100,000 Population

Year

Black 

Male

White 

Male

Black 

Female

White 

Female

1981 23.3 18.6 18.3 13.5

1982 23.8 19.2 19.1 14.2

1983 25.3 20.4 19.7 15.3

1984 26.9 21.1 21.0 16.0

1985 27.8 21.5 22.0 17.0

1986 28.2 22.7 23.4 17.7

1987 27.9 22.4 21.7 18.1

1988 28.5 23.1 22.7 18.4

1989 25.2 19.9 21.2 16.5

1990 24.3 19.1 19.1 15.9

1991 22.7 19.1 19.1 16.1

1992 22.0 19.1 18.4 16.1

1993 23.8 21.0 20.2 18.0

1994 22.7 20.4 18.6 17.5

1995 23.1 20.4 18.8 17.7

1996 22.7 20.4 18.8 17.4

1997 21.9 20.4 19.0 17.8

1998 23.2 20.2 19.2 18.0

1999 25.3 21.4 20.9 19.3

2000 24.1 21.6 20.7 19.3

2001 24.4 21.2 20.6 19.3

2002 23.3 20.5 20.5 18.6

2003 23.5 20.7 20.5 18.4

2004 23.4 20.0 19.3 18.1

2005 23.0 20.0 20.4 18.1

2006 23.0 20.0 19.3 18.1
45

Chart 3–40 

Age-Adjusted Death Rates for Any Mention of Heart Failure by Race and Sex, U.S., 1981–2006

From 1989 to 2006, death rates for any mention of HF on the death certificate declined for blacks and whites, both 

male and female. From 1981 to 2000, mortality in males was higher in whites than in blacks and then was similar 

through 2006. This is in contrast to HF solely as the underlying cause (also see Chart 3–39).36

 Deaths/100,000 Population

Year

Black 

Male

White 

Male

Black 

Female

White 

Female

1981 146.1 162.4 114.5 116.4

1982 141.6 159.8 112.1 115.2

1983 142.5 159.0 113.1 115.7

1984 140.4 157.2 112.4 114.5

1985 145.3 156.4 114.1 113.8

1986 145.1 152.0 115.1 112.4

1987 141.3 148.9 112.2 111.0

1988 146.2 149.4 118.2 111.5

1989 141.5 143.6 118.1 108.8

1990 142.7 144.3 114.1 107.9

1991 138.3 141.9 112.0 106.1

1992 136.4 140.4 107.2 104.0

1993 138.3 143.1 112.3 107.7

1994 132.6 138.0 107.1 103.6

1995 132.7 135.9 105.6 102.5

1996 129.2 132.1 103.1 99.1

1997 124.1 129.7 102.0 97.9

1998 125.8 126.7 103.0 96.2

1999 121.9 123.3 98.9 94.7

2000 121.4 122.5 100.5 95.2

2001 118.6 117.5 96.6 92.6

2002 113.1 114.3 95.9 89.4

2003 112.0 113.2 93.6 88.6

2004 111.0 109.3 89.8 85.4

2005 112.4 108.7 91.0 85.4

2006 105.9 103.7 84.4 80.3

Chart 3–41 

Age-Adjusted Death Rates for Heart Failure as the Underlying Cause of Death by Race/Ethnicity 

and Sex, U.S., 2006

In 2006, death rates for HF as the underlying cause were slightly higher in males than in females. Within sex 

groups, death rates were highest in non-Hispanic blacks and non-Hispanic whites and lowest in Asians.36

 Deaths/100,000 Population

Race/Ethnicity Male Female

Total 20.0 17.9

Black* 23.6 19.6

White* 20.7 18.5

American Indian 13.3 11.5

Hispanic 10.6 9.4

Asian 6.6 6.2

* Non-Hispanic.
46

Chart 3–42 

Age-Adjusted Death Rates for Any Mention of Heart Failure by Race/Ethnicity and Sex, U.S., 

2006

In 2006, death rates for any mention of HF on the death certificate were higher in males than in females. Within 

sex groups, death rates were highest in non-Hispanic blacks and non-Hispanic whites and lowest in Asians.36

 Deaths/100,000 Population

Race/Ethnicity Male Female

Total 102.5 79.8

Black* 108.0 85.8

White* 106.0 81.7

American Indian 72.3 58.4

Hispanic 64.7 52.8

Asian 48.0 37.5

* Non-Hispanic.

Chart 3–43 

Death Rates for Heart Failure as the Underlying Cause by Age, Race, and Sex, U.S., 2006

In 2006, HF mortality as the underlying cause increased with age. Within sex groups, rates were higher in blacks 

than in whites; and within racial groups, rates were higher in males than in females.36

 Deaths/100,000 Population

Age

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

25–44 1.9 0.4 1.1 0.3

45–54 11.1 2.8 6.0 1.5

55–64 23.4 9.8 16.3 6.1

65–74 63.3 35.5 43.2 25.9

75–84 164.8 151.2 137.0 123.1

Chart 3–44 

Death Rates for Any Mention of Heart Failure by Age, Race, and Sex, U.S., 2006

In 2006, mortality for any mention of HF on the death certificate was higher in blacks than in whites within sex 

groups and at all ages, with one exception: For those aged 75–84 years, the death rate in white males surpassed 

the rate in black males. Within racial groups, death rates for HF were higher in males than in females.36

 Deaths/100,000 Population

Age

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

25–44 8.9 2.7 6.1 1.7

45–54 48.6 15.8 29.3 8.9

55–64 120.0 58.1 80.7 35.4

65–74 324.5 217.0 214.2 141.7

75–84 792.8 827.4 608.9 586.3
47

Chart 3–45 

Age-Adjusted Death Rates for Cardiomyopathy by Race and Sex, U.S., 2006

In 2006, the death rate for cardiomyopathy was about twice as high in males than in females and nearly twice as 

high in blacks than in whites.35 

 Deaths/100,000 Population

Race Male Female 

Total 11.00 5.60

White 10.20 5.10

Black 19.30 9.90

Chart 3–46 

Death Rates for Cardiomyopathy by Age, Race, and Sex, U.S., 2006

In 2006, within sex groups, cardiomyopathy mortality was much higher in blacks than in whites at all ages from 

35–44 to 75–84 years. Within racial groups, cardiomyopathy mortality was higher in males than in females.35

 Deaths/100,000 Population

Age

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

35–44 10.7 3.4 4.5 1.5

45–54 21.3 6.6 8.6 2.8

55–64 35.8 11.7 15.2 4.9

65–74 56.7 26.2 26.4 12.0

75–84 94.7 68.8 57.6 33.7
48

Chart 3–47 

Hospitalizations for Atrial Fibrillation by Primary and Secondary Diagnosis, U.S., 1982–2006

The number of hospitalizations for atrial fibrillation as a primary diagnosis was more than 2.5 times higher in 

2006 than in 1988. As a secondary diagnosis, the number of hospitalizations was 3 times higher in 2006 than in 

1988.33, 34

 Hospitalizations (Thousands)

Year

Primary 

Diagnosis

Secondary

Diagnosis

1982 115 429

1983 115 473

1984 111 553

1985 142 612

1986 150 693

1987 146 749

1988 171 820

1989 162 888

1990 181 922

1991 210 1,031

1992 227 1,133

1993 240 1,215

1994 277 1,309

1995 270 1,348

1996 286 1,528

1997 319 1,692

1998 327 1,774

1999 347 1,872

2000 399 2,001

2001 416 2,097

2002 465 2,258

2003 470 2,434

2004 444 2,492

2005 454 2,641

2006 461 2,621
49

Chart 3–48 

Hospitalization Rates for Atrial Fibrillation by Age, U.S., 1982–2006

From 1988 to 2006, hospitalization rates for atrial fibrillation nearly doubled for those aged 45–64 years and 

slightly more than doubled for those aged 65 years and older.33, 34

 Hospitalizations/10,000 Population

Year Ages 45–64 Years Ages 65 Years

1982 6.8 28.3

1983 7.0 27.4

1984 6.3 26.7

1985 8.7 34.0

1986 8.2 37.0

1987 6.8 35.9

1988 8.5 40.2

1989 8.4 36.8

1990 9.6 40.2

1991 10.1 47.9

1992 10.4 51.1

1993 9.9 54.3

1994 10.6 62.4

1995 10.5 60.5

1996 11.4 62.3

1997 11.6 70.5

1998 13.5 68.6

1999 12.4 74.2

2000 14.8 84.4

2001 13.2 88.1

2002 14.6 96.9

2003 18.0 90.5

2004 15.3 84.6

2005 14.6 88.9

2006 15.6 86.2
50

Chart 3–49 

Age-Adjusted Prevalence of Stroke by Race and Sex, Ages 25–74, U.S., 1971–1975 to 2003–2006

From 1971–1975 to 2003–2006, the prevalence of stroke mostly increased in blacks, whites, and females. In 

males, the prevalence increased from 1971–1975 to 1988–1994 and then decreased in 1999–2002.17

 Percent of Population

Years Black White Male Female

1971–1975 2.12 1.30 1.45 1.32

1976–1980 2.21 1.40 1.57 1.37

1988–1994 2.53 1.61 2.01 1.41

1999–2002 3.44 1.67 1.79 1.98

2003–2006 3.34 2.01 1.75 2.70

Chart 3–50 

Prevalence of Stroke by Age and Sex, U.S., 1999–2006

In 1999–2006, the prevalence of stroke, which increased with age, was higher in females than in males through 

age 55–64 years; it was higher in males than in females aged 65 years and older.17

 Percent of Population

Age (Years) Male Female

35–44 0.8 1.1

45–54 1.0 2.6

55–64 2.8 4.0

65–74 7.3 5.8

75 12.5 11.9

Chart 3–51 

Prevalence of Stroke by Age and Race, U.S., 1999–2006

In 1999–2006, the prevalence of stroke increased with age and was higher in blacks than in whites at all ages.17

 Percent of Population

Age (Years) Black White

35–44 1.6 1.0

45–54 3.6 1.4

55–64 5.9 3.0

65–74 10.4 5.8

75 14.9 12.2
51

Chart 3–52 

Hospitalization Rates for Stroke, Ages 45–64 and 65 and Over, U.S., 1971–2006

Hospitalization rates for stroke in those aged 45–64 years increased from 1971 to the mid-1980s, then remained 

relatively stable through 2006. For those aged 65 years and older, the rates generally rose from 1971 to 1997, and 

subsequently declined through 2006.33, 34

 Hospitalizations/10,000 Population

Year Ages 45–64 Years Ages 65 Years

1971 30.1 192.6

1972 34.8 207.1

1973 35.0 211.0

1974 35.2 214.9

1975 34.8 202.1

1976 33.9 207.3

1977 34.8 204.8

1978 35.4 204.1

1979 37.4 237.1

1980 38.5 231.6

1981 39.7 226.2

1982 40.6 230.1

1983 41.5 234.1

1984 42.9 237.8

1985 42.9 240.3

1986 39.5 231.0

1987 42.3 223.0

1988 37.2 190.4

1989 33.6 192.6

1990 33.2 193.1

1991 33.5 201.5

1992 35.6 193.6

1993 34.7 192.0

1994 35.1 204.4

1995 34.8 209.8

1996 34.8 214.7

1997 36.5 228.6

1998 38.2 218.7

1999 36.3 205.5

2000 37.4 204.1

2001 31.6 194.1

2002 34.4 187.9

2003 33.6 190.5

2004 30.8 175.6

2005 29.5 170.2

2006 31.3 161.8
52

Chart 3–53 

Hospital Case-Fatality Rate for Stroke, Ages Younger Than 65 and 65 and Over, U.S., 1971–2006*

Hospital case-fatality rates for stroke in patients younger than 65 years declined appreciably from 1971 to 1983 

and then fluctuated through 2006. For those aged 65 years and older, the rates continued to decline until 1997 

and then stabilized.33, 34

 Percent Discharged Dead

Year Ages <65 Years Ages 65 Years

1971 17.7 20.1

1972 16.7 20.8

1973 15.2 20.2

1974 13.4 16.9

1975 12.9 17.8

1976 — —

1977 — —

1978 11.3 15.5

1979 9.5 14.0

1980 7.0 14.8

1981 9.6 11.5

1982 7.3 11.5

1983 5.9 10.7

1984 6.3 10.1

1985 6.2 9.5

1986 6.9 9.9

1987 7.2 9.8

1988 5.9 11.1

1989 5.2 9.1

1990 6.0 8.9

1991 6.1 8.9

1992 7.4 7.3

1993 5.4 7.8

1994 5.9 7.2

1995 5.9 7.7

1996 4.9 7.0

1997 6.3 6.2

1998 6.1 6.6

1999 5.4 7.6

2000 5.8 6.6

2001 6.5 6.1

2002 5.3 6.9

2003 3.4 6.0

2004 6.5 6.8

2005 6.6 6.4

2006 3.8 6.0

* Estimates are not available for 1976 and 1977.
53

Chart 3–54 

Age-Adjusted Death Rates for Stroke by Race and Sex, U.S., 1950–2006

The steep decline in stroke mortality that occurred for black and for white males and females in the 1970s and 

mid-1980s slowed through the 1990s before resuming in 2001.31, 32

 Deaths/100,000 Population

Year

Black* 

Male

White 

Male

Black*

Female White Female

1950 231.3 182.1 240.6 169.7

1951 230.3 180.7 237.3 172.1

1952 233.7 180.1 235.0 170.0

1953 226.5 178.7 228.6 169.9

1954 221.1 173.0 223.7 163.9

1955 222.8 178.8 221.9 167.0

1956 221.8 178.8 225.0 166.9

1957 231.8 185.4 231.5 171.1

1958 237.7 184.3 229.3 172.0

1959 227.2 181.6 229.2 167.2

1960 230.4 181.6 225.2 164.9

1961 219.7 176.7 219.5 160.6

1962 229.0 178.7 225.5 161.6

1963 234.1 179.1 222.0 160.7

1964 220.5 171.9 209.6 153.5

1965 222.9 171.8 210.1 152.3

1966 222.0 171.2 205.0 152.0

1967 206.5 166.5 190.6 145.9

1968 232.8 169.2 208.9 148.4

1969 221.7 162.4 197.2 141.9

1970 206.4 153.7 189.3 135.5

1971 200.4 156.6 179.7 134.3

1972 200.8 156.2 178.8 134.2

1973 197.6 151.7 175.7 133.6

1974 184.6 144.1 160.6 125.9

1975 167.8 130.9 145.1 113.3

1976 162.3 123.3 138.2 108.3

1977 153.1 116.1 132.4 101.4

1978 145.7 107.8 124.4 95.8

1979 139.5 100.3 117.4 89.8

1980 142.0 98.7 119.6 89.0

1981 132.0 91.2 112.6 83.1

1982 123.8 86.1 105.8 78.0

1983 118.0 83.3 104.2 74.8

1984 115.0 80.2 100.2 72.9

1985 112.5 77.1 99.2 70.7

1986 110.7 73.4 93.5 67.9

1987 108.2 71.8 91.5 66.5

1988 109.5 71.4 92.4 64.9

1989 104.0 67.1 89.5 61.6

1990 102.2 65.5 84.0 60.3

1991 100.9 63.1 80.7 57.8

1992 94.7 62.2 78.1 56.6

1993 96.2 63.5 78.9 57.8

1994 96.5 63.1 78.8 57.7

1995 97.0 62.9 79.4 58.6

1996 94.4 62.6 77.3 58.0

1997 89.7 61.4 74.4 56.8

1998 88.0 58.1 73.7 55.8

1999 89.6 60.8 76.2 58.0

2000 89.6 59.8 76.2 57.3

2001 85.4 56.5 73.7 54.5

2002 81.7 54.2 71.8 53.4

2003 79.5 51.7 69.8 50.5

2004 74.9 48.1 65.5 47.2

2005 70.5 44.7 60.7 44.0

2006 67.1 41.7 57.0 41.1

* Nonwhite from 1950 to 1967.
54

Chart 3–55 

Deaths and Age-Adjusted Death Rates for Stroke, U.S., 1979–2006*

From 1980 to the early 1990s, the number of deaths and the age-adjusted death rates for stroke declined. The 

number of deaths remained relatively stable after the mid-1990s but began to decline again after 2000. The ageadjusted death rates were stable for most of the 1990s but began to decline in 1998 through 2006.31, 32

Year

Deaths in

Thousands

Deaths/100,000 

Population

1979 178 102.0

1980 179 101.0

1981 172 94.0

1982 166 88.4

1983 163 85.3

1984 162 82.7

1985 161 80.2

1986 157 76.8

1987 157 75.2

1988 158 74.1

1989 153 70.3

1990 151 68.6

1991 150 66.1

1992 151 64.6

1993 158 65.8

1994 161 65.7

1995 166 66.3

1996 168 65.6

1997 168 64.2

1998 166 62.3

1999 167 61.6

2000 168 60.9

2001 164 57.9

2002 163 56.2

2003 158 53.5

2004 150 50.0

2005 144 46.6

2006 137 43.6

* The comparability ratio 1.0502 was applied to the deaths and rates reported in vital statistics for 1979–1998.
55

Chart 3–56 

Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 1999–2006

From 1999 to 2006, stroke mortality declined for non-Hispanic blacks, non-Hispanic whites, Asians, Hispanics, 

and American Indians, both male and female.36

 Male (Deaths/100,000 Population)

Year Black* White*

American 

Indian Hispanic Asian

1999 90.6 60.8 50.0 52.6 58.7

2000 90.8 59.9 46.1 50.5 58.0

2001 86.5 56.5 37.5 48.9 55.3

2002 83.0 54.4 37.1 44.3 50.8

2003 81.0 51.9 34.9 43.0 48.4

2004 76.3 48.2 35.0 41.5 44.2

2005 71.8 44.8 31.3 38.0 41.5

2006 68.4 41.7 25.8 35.9 39.8

 Female (Deaths/100,000 Population)

Year Black* White*

American 

Indian Hispanic Asian

1999 77.1 58.4 46.4 42.2 49.0

2000 77.2 57.6 43.7 43.0 49.1

2001 74.8 54.8 44.0 41.6 48.2

2002 72.8 53.9 38.0 38.6 45.4

2003 70.9 50.9 34.2 38.1 42.6

2004 66.6 47.7 35.1 35.4 38.9

2005 61.7 44.4 37.1 33.5 36.3

2006 58.0 41.5 30.9 32.3 34.9

* Non-Hispanic.

Chart 3–57 

Average Annual Percent Change in Age-Adjusted Death Rates for Stroke by Race and Sex, 

U.S., 1960–2006

The steep average annual declines in stroke mortality that occurred in males and females, and in blacks and 

whites, from 1968 to 1989 were followed by modest reductions for several years. Appreciable annual declines—

almost 5% overall—resumed in 1999 through 2006.31, 32

Years

Total

Population

Black*

Male

White

Male

Black*

Female

White

Female

1960–1967 -1.4 -1.0 -1.1 -2.1 -1.6

1968–1978 -4.2 -4.4 -4.2 -5.0 -4.1

1979–1989 -3.7 -3.0 -3.9 -3.0 -3.7

1989–1998 -0.9 -1.6 -1.1 -1.7 -0.7

1999–2006 -4.9 -4.2 -5.4 -4.1 -4.9

* Nonwhite from 1960 to 1967.
56

Chart 3–58 

Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 2006

In 2006, stroke mortality was about the same in males and females. By race/ethnicity, death rates were highest in 

non-Hispanic blacks and lowest in American Indians.36

Deaths/100,000 Population

Race/Ethnicity Male Female

Total 43.9 42.6

Black* 68.4 58.0

White* 41.7 41.5

American Indian 25.8 30.9

Hispanic 35.9 32.3

Asian 39.8 34.9

* Non-Hispanic.

Chart 3–59 

Death Rates for Stroke in Males by Age and Race/Ethnicity, U.S., 2006

In 2006, stroke mortality in males increased with age from 45–54 to 75–84 years for non-Hispanic blacks, nonHispanic whites, Hispanics, American Indians, and Asians.36

 Deaths/100,000 Population

Age 

(Years) Black* White*

American

Indian Hispanic Asian

45–54 44.6 12.1 16.3 17.0 13.4

55–64 108.6 30.3 35.0 41.1 36.3

65–74 222.7 96.5 82.9 100.1 108.9

75–84 479.4 340.5 174.3 292.8 294.9

* Non-Hispanic.

Chart 3–60 

Death Rates for Stroke in Females by Age and Race/Ethnicity, U.S., 2006

In 2006, stroke mortality in females increased with age from 45–54 to 75–84 years for non-Hispanic blacks, nonHispanic whites, Hispanics, American Indians, and Asians.36

 Deaths/100,000 Population

Age 

(Years) Black* White*

American

Indian† Hispanic Asian

45–54 32.1 10.1 — 11.8 10.4

55–64 61.5 23.5 16.2 27.8 28.8

65–74 151.8 79.0 78.8 76.9 80.8

75–84 421.9 325.9 267.6 240.6 284.2

* Non-Hispanic.

† Data unreliable for American Indian females aged 45–54 years.
57

Chart 3–61 

Age-Adjusted Death Rates for Stroke by State, U.S., 2003–2005

In 2003–2005, stroke mortality was highest in many of the Southeastern states, most of which comprise “the 

stroke belt.”15

Rank State Deaths/100,000 Population

1 Tennessee 63.7

2 Arkansas 63.6

3 South Carolina 63.5

4 Alabama 62.9

5 Oklahoma 61.0

6 North Carolina 60.9

7 Oregon 60.6

8 Louisiana 58.5

9 Mississippi 58.2

10 Georgia 58.1

11 Kentucky 55.8

12 Virginia 55.7

13 Alaska 55.5

14 Idaho 55.3

15 West Virginia 55.1

16 Texas 54.4

17 Missouri 54.4

18 Indiana 54.2

19 Washington 54.2

20 California 52.7

21 Kansas 52.5

22 Ohio 52.3

23 Nevada 51.6

24 Michigan 51.2

25 Maryland 51.1

26 North Dakota 51.0

27 Illinois 50.9

28 Iowa 50.5

29 Wisconsin 50.0

30 Hawaii 49.9

31 Nebraska 49.7

32 South Dakota 49.6

33 Montana 49.5

34 Pennsylvania 49.2

35 Maine 48.6

36 Utah 48.2

37 Wyoming 46.7

38 Colorado 45.7

39 Minnesota 45.6

40 Delaware 44.3

41 Massachusetts 42.8

42 Vermont 42.3

43 Arizona 41.3

44 New Hampshire 41.0

45 New Mexico 40.7

46 Rhode Island 40.6

47 Florida 40.4

48 New Jersey 40.2

49 Connecticut 40.2

50 New York 33.2
58

Chart 3–62 

Age-Adjusted Death Rates* for Stroke by Country and Sex, Ages 35–74, 2007

In 2006–2007, among 16 industrialized countries, the United States ranked 11th highest in stroke mortality in 

males and 10th in females. Eastern European countries had markedly higher death rates for stroke compared with 

other countries.45

 Deaths/100,000 Population

Country Male Female

Romania 216.4 134.0

Poland 104.8 56.1

Republic of Korea (2006)† 93.1 50.8

Czech Republic 69.0 38.3

Japan 56.3 25.3

Finland 47.4 25.3

Scotland 46.1 33.0

Denmark (2006)† 45.6 32.1

Germany (2006)† 34.5 20.1

England and Wales 32.7 25.4

United States of America (2006)† 32.3 25.3

Italy (2006)† 31.9 19.3

Netherlands 28.8 22.8

Norway (2006)† 28.3 19.9

France (2006)† 27.7 15.2

Sweden (2006)† 19.3 21.2

* Age adjusted to European standard.

†

 Data for 2006.

Chart 3–63 

Change in Age-Adjusted Death Rates* for Stroke in Males by Country, Ages 35–74, 1999–2007†

From 1999 to 2005–2007, among 13 industrialized countries, 11 had a steeper average annual decline in stroke 

mortality in males than the United States.45

Country

Average Annual 

Percent Change‡

Republic of Korea (1999–2006) -7.7

England and Wales (2001–2007) -7.3

Norway (1999–2006) -6.9

Czech Republic (1999–2007) -6.3

Netherlands (1999–2007) -6.2

Germany (1999–2006) -6.1

France (2000–2006) -4.9

Finland (1999–2007) -4.8

Denmark (1999–2006) -4.2

Poland (1999–2006) -3.8

Japan (1999–2007) -3.6

United States of America (1999–2006) -3.4

Romania (1999–2007) -2.8

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.
59

Chart 3–64 

Change in Age-Adjusted Death Rates* for Stroke in Females by Country, Ages 35–74, 1999–2007†

From 1999 to 2007, when compared with the United States, 9 of the 13 countries shown had steeper average 

annual declines in stroke mortality in females.45

Country

Average Annual 

Percent Change‡

Republic of Korea (1999–2006) -9.1

Czech Republic (1999–2006) -7.4

England and Wales (2001–2007) -6.7

Germany (1999–2006) -6.3

Netherlands (1999–2007) -6.0

Finland (1999–2007) -4.9

Japan (1999–2007) -4.6

Norway (1999–2006) -4.4

France (2000–2006) -4.3

United States of America (1999–2006) -3.6

Romania (1999–2007) -3.5

Denmark (1999–2006) -3.4

Poland (1999–2006) -1.6

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.

Chart 3–65 

Prevalence of Hypertension* and Prehypertension†

 by Age, U.S., 1999–2006

In 1999–2006, the prevalence of hypertension was 40% among those aged 50–59 years and 73% among those 

aged 80 years and older. These percentages are considerably higher when prehypertension is included.17

 Percent of Population

Age (Years) Hypertension Prehypertension 

18–29 4.1 26.9

30–39 10.0 29.5

40–49 23.6 34.2

50–59 40.2 31.0

60–69 59.9 22.4

70–79 70.2 16.1

80 73.0 15.5

* Hypertension is defined as systolic BP ≥140 mmHg, or diastolic BP ≥90, or on medication.

†

 Prehypertension is defined as systolic BP 120–139 mmHg or diastolic BP 80–89.
60

Chart 3–66 

Age-Adjusted Prevalence of Hypertension* by Race/Ethnicity and Sex, Ages 20–74, U.S.,

1999–2006

In 1999–2006, the prevalence of hypertension was appreciably higher in non-Hispanic blacks than in nonHispanic whites or Mexican-Americans aged 20–74 years. Within racial groups, the prevalence of hypertension 

was similar in males and females.17

 Percent of Population

Race/Ethnicity Male Female

Black† 36.0 37.8

White† 25.6 23.1

Mexican-American 20.8 21.8

* Hypertension is defined as systolic BP ≥140 mmHg, or diastolic BP ≥90, or on medication.

†

 Non-Hispanic.

Chart 3–67 

Age-Adjusted Prevalence of Hypertension* by Race/Ethnicity and Sex, Ages 20–74, U.S., 

1976–1980 to 2003–2006

From 1976–1980 to 1988–1994, the prevalence of hypertension decreased substantially in both non-Hispanic 

whites and blacks and in males and females and remained relatively stable through 2003–2006. In MexicanAmerican males, it was stable from 1976–1980 through 1988–1994 before decreasing slightly in 1999–2002 and 

remaining unchanged in 2003–2006. The prevalence of hypertension was stable for the entire time in MexicanAmerican females.17

 Percent of Population

Years

White†

Male

White†

Female

Black†

Male

Black†

Female

Mexican-American 

Male

Mexican-American 

Female

1976–1980 45.0 33.7 50.7 51.1 25.6 22.5

1988–1994 25.8 19.7 36.5 36.4 25.9 22.3

1999–2002 23.6 22.8 35.0 37.4 20.9 21.5

2003–2006 27.5 23.3 36.8 38.2 20.8 22.2

* Hypertension is defined as systolic BP ≥140 mmHg, or diastolic BP ≥90, or on medication.

†

 Non-Hispanic.
61

Chart 3–68 

Hypertensive* Population Aware, Treated, and Controlled, Ages 18–74, U.S., 1971–1972 to 

2003–2006

In 2003–2006, 93% of persons with a high level of hypertension (160/95+ mmHg) were aware of their condition, 

compared with 51% in 1971–1972. The percent of hypertensive persons treated and controlled increased from 

16% in 1971–1972 to 79% in 2003–2006.17

 Percent of Hypertensive Population

Years Unaware

On Medication 

Controlled

On Medication 

Uncontrolled

No Medication 

Uncontrolled

1971–1972 49 16 20 15

1974–1975 36 20 14 30

1976–1980 27 34 12 27

1988–1994 12 65 14 9

1999–2002 11 70 13 6

2003–2006 7 79 9 5

* Hypertension is defined as systolic BP ≥160 mmHg, or diastolic BP ≥95 mmHg, or on medication.

Chart 3–69 

Hypertensive* Population Aware, Treated, and Controlled, Ages 18–74, U.S., 1976–1980 to 

2003–2006

In 2003–2006, for hypertension of 140/90+ mmHg, 78% of hypertensive persons were aware of their condition; 

67% were on treatment for it; and 45% had it controlled. These percentages are appreciably greater than the 

comparable figures (51%, 31%, and 10%, respectively) for 1976–1980.17

 Percent of Hypertensive Population

Years Unaware On Medication Controlled

On Medication 

Uncontrolled

No Medication 

Uncontrolled

1976–1980 49 10 21 20

1988–1991 27 29 26 18

1991–1994 32 27 27 14

1999–2002 30 36 23 11

2003–2006 22 45 22 11

* Hypertension is defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on medication.

Chart 3–70 

Age-Adjusted Death Rates for Diseases of the Arteries by Race and Sex, U.S., 2006

In 2006, death rates for diseases of the arteries within sex groups were higher in blacks than in whites. Overall, 

death rates were higher in males than in females.31

 Deaths/100,000 Population

Race Male Female

Total 12.2 8.2

White 12.2 8.2

Black 13.6 10.2
62

Chart 3–71 

Death Rates for Diseases of the Arteries by Age, Race, and Sex, U.S., 2006

In 2006, death rates for diseases of the arteries within racial groups were higher in males than in females at all 

ages. Rates were higher in black males and females than in white males and females, respectively, except for 

those aged 75–84 years, where white males had a higher rate than black males.35

 Deaths/100,000 Population

Age 

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

35–44 3.3 1.3 1.2 0.6

45–54 8.6 3.8 4.2 1.5

55–64 19.3 10.7 9.0 5.8

65–74 43.4 34.4 25.3 19.0

75–84 93.1 96.5 80.8 64.1

Chart 3–72 

Percent of Deaths From Congenital Malformations of the Circulatory System, Age Under 1, U.S., 

1940–2006

The percentage of deaths from congenital malformations of the circulatory system for infants aged less than 

1 year declined from 82% in 1940 to 46% in 2006.31, 32

Year Percent of Deaths

1940 82.0

1950 75.1

1960 67.3

1970 63.7

1980 57.5

1990 53.3

2000 42.7

2003 42.2

2004 42.6

2005 44.6

2006 46.2
63

Chart 3–73 

Infant Mortality From Congenital Malformations of the Circulatory System by Race, U.S.,

1970–2006

Infant congenital heart disease mortality declined from 1970 to 2006 in blacks and in whites. Mortality from 

other congenital malformations of the circulatory system did not decline until the mid-1980s in blacks and whites 

and continued through 2003 in blacks. In whites, the rates were stable during the 2000s.31, 32

 Deaths/100,000 Live Births

Year Heart White Heart Black Other CVD White Other CVD Black

1970 120.2 113.4 19.8 19.8

1971 114.2 105.2 22.4 20.9

1972 114.7 106.5 16.1 17.9

1973 107.8 103.3 20.7 19.6

1974 100.0 100.1 19.6 22.1

1975 96.6 92.3 21.9 24.0

1976 91.5 87.6 21.0 25.5

1977 90.6 84.6 22.0 27.4

1978 85.2 83.6 23.6 33.0

1979 83.3 80.3 22.8 32.5

1980 80.3 78.9 24.5 34.4

1981 74.2 73.7 22.7 37.8

1982 77.1 76.6 21.7 39.7

1983 70.3 74.1 23.6 36.9

1984 69.8 74.9 20.3 32.1

1985 69.2 72.7 17.4 25.6

1986 65.1 69.2 14.5 25.4

1987 62.0 71.4 14.5 21.7

1988 67.7 64.6 14.0 20.5

1989 62.1 71.2 11.1 18.4

1990 61.3 72.2 11.4 16.7

1991 56.3 70.3 10.7 17.7

1992 55.0 71.8 10.1 15.3

1993 54.0 64.7 9.6 14.6

1994 53.4 62.1 9.5 16.0

1995 50.1 58.5 7.7 10.1

1996 48.7 58.5 8.5 11.4

1997 45.2 51.3 7.9 11.3

1998 44.5 51.3 7.2 12.3

1999 40.0 47.9 4.9 9.4

2000 38.6 50.9 4.7 7.9

2001 37.0 51.3 4.5 6.4

2002 35.7 50.4 5.0 8.4

2003 33.8 45.8 5.7 6.5

2004 32.8 45.3 5.5 10.7

2005 33.3 38.1 5.3 9.6

2006 31.5 43.4 5.0 9.2
64

4. Lung Diseases

The term lung diseases is used here to mean: 

•	 Acute lower respiratory infections

•	 Chronic lower respiratory diseases

•	 Lung diseases due to external agents

•	 Adult respiratory distress syndrome

•	 Pulmonary edema

•	 Interstitial lung diseases

•	 Cardiopulmonary diseases

•	 Selected HIV-related and other pulmonary infections

•	 Neonatal pulmonary diseases

Chart 4–1 shows the distribution of deaths in 2006 by major lung subgroups.35 For lung diseases (excluding lung 

cancer), Chart 4–2 shows, according to ICD‐9‐CM codes, the estimated number of physician office visits, the estimated number of hospitalizations, and the average length of hospital stay in 2006 and according to ICD-10 codes, 

the estimated number of deaths in 2006.34, 35, 44 Subsequent charts display morbidity and mortality for total lung 

diseases and specific subgroups: COPD, asthma, neonatal respiratory distress syndrome (RDS), and sudden infant 

death syndrome (SIDS).

Chronic Obstructive Pulmonary Disease

The term COPD is used here to include chronic bronchitis and emphysema. It has been defined recently as “the 

physiologic finding of nonreversible pulmonary function impairment.”25

COPD prevalence charts in this Chart Book are based on physician-diagnosed COPD. Prevalence is determined 

from annual COPD data, which are obtained from NHIS, of self-reports of lifetime prevalence. In 2007, an estimated 12 million individuals were identified with COPD.24 Additionally, based on spirometry readings of lung 

function in the 1988–1994 NHANES, COPD was estimated to go undiagnosed in 12 million people.25 

Asthma

Three different prevalence estimates derived from NHIS data are found in this chapter. Before 1997, prevalence 

was based on NHIS estimates of individuals who had or knew someone in the family who had asthma during the 

past 12 months. Beginning in 1997, “attack prevalence” was introduced to limit the count to individuals who 

responded yes to the following questions:

•	 Have you ever been told by a doctor or other health professional that you have asthma?

•	 During the past 12 months, have you had an episode of asthma or asthma attack?

As a result, the estimates from 1997 to 2007 are not comparable to those based on NHIS data prior to 1997. 

Charts 4–18 and 4–19 indicate this change by breaking the asthma prevalence trend line between 1996 and 1997.

In 2001, a question was added to the survey to determine “current prevalence” or simply, prevalence. “Do you 

still have it?” is the question asked of those who have been told by a doctor or other health professional that they 

have asthma. Current prevalence is based on individuals who respond yes to that question. (See Charts 4–18 to 

4–21.)
65

Chart 4–1 

Deaths From Lung Diseases, Percent by Subgroup, U.S., 2006

Conditions Percent

COPD 53.6

Influenza and pneumonia 25.0

External agents 8.0

Cardiopulmonary diseases 5.5

Other 4.1

Neonatal pulmonary disorders 2.1

Asthma 1.6

Total Deaths = 225,028 (100%)

Chart 4–2 

Number of Hospitalizations, Physician Office Visits,* and Deaths for Lung Diseases,†

 U.S., 2006

 Hospitalizations 

Diagnostic Category ICD-9-CM Codes

First-Listed 

Discharges 

(1,000)

Length of 

Stay 

(Days)

Physician Office 

Visits (1,000) ICD-10 Codes Deaths

Total 3,376 5.3 35,323 225,028

Acute lower respiratory infections: 466, 480–487 1,487 4.8 6,988 J10–J18, J20, J21 56,540

Influenza and pneumonia 480–487 1,270 5.0 4,030 J10–J18 56,326

Acute bronchitis 466 217 3.2 2,959 J20 137

Acute bronchiolitis included in 466 — — — J21 77

Chronic lower respiratory disease: 277.0, 490–496 1,125 4.0 26,939 J40–J47, E84 125,021

COPD: 490–492, 494–496 670 4.4 16,343 J40–J44, J47 120,970

Chronic bronchitis 490, 491 537 4.6 9,856 J40–J42 740

Emphysema 492 19 4.4 324 J43 12,551

Other COPD 495, 496 105 3.1 6,081 J44 106,706

Bronchiectasis 494 9 6.2 82 J47 973

Asthma 493 444 3.2 10,590 J45 3,365

Status asthmaticus included in 493 — — — J46 248

Cystic fibrosis 277.0 11 9.5 6 E84 438

Lung disease due to external agents 500–508 180 7.5 47 J60–J70 17,899

Adult respiratory distress syndrome 518.5 7 10.3 — J80 1,609

Pulmonary edema 518.4 — — — J81 572

Interstitial lung diseases: 011, 012, 135, 446.2, 446.4, 518.8 356 8.8 1,309 A15, A16, A19, A31.0, D86, 

J96, J99, M31.0, M31.3

5,849

Sarcoidosis 135 8 6.4 435 D86 931

Respiratory tuberculosis 011, 012 8 7.0 49 A15, A16, A19, A31.0 731

Respiratory failure 518.8 340 8.9 663 J96 3,769

Pulmonary manifestations of connective 

tissue disorders

446.2, 446.4 — — 163 J99, M31.0, M31.3 418

Cardiopulmonary diseases: 415.1–417 160 5.7 264 I26, I27 12,317

Pulmonary embolism 415.1 145 5.6 128 I26 6,924

Other pulmonary heart disease 415.2–417 15 6.5 136 I27 5,393

Selected HIV-related and other pulmonary 

infections

114–116, 117.3, 117.5, 117.7, 

136.3

— — 76 B38–40, B44–46, B59 576

Neonatal pulmonary disorders: 748.4–748.6, 769, 770, 798.0 61 15.5 — P22, P25–P28, Q33, R95 4,645

Respiratory distress syndrome 769 19 29.1 — P22 825

Sudden infant death syndrome 798.0 — — — R95 2,323

Congenital malformation of the lung 748.4–748.6 1 4.1 — Q33 408

Bronchopulmonary dysplasia 770.7 — — — P27.1 260

Atelectasis of newborn 770.4, 770.5 — — — P28.0, P28.1 399

Other perinatal respiratory diseases 770.1–770.3, 770.6, 770.8, 770.9 27 7.6 — P25, P26, P27.0, P27.8, P27.9, 

P28.2–P28.9

398

* Estimates of hospitalizations and physician office visits are subject to sampling variability. Estimates of hospitalizations at 10,000 or below 

have a relative standard error of more than 18%. Estimates of physician office visits below 1 million have a relative standard error of more 

than 30%. 

†

 Does not include lung cancer. 
66

Chart 4–3 

Age-Adjusted Death Rates for Total Lung Diseases by Race and Sex, U.S., 2006

In 2006, total lung disease mortality was one-third higher in males than in females. Within sex groups, it was 

slightly higher in black males than in white males but was lower in black females than in white females.35

 Deaths/100,000 Population

Race Male Female

Total 85.7 63.8

White 86.5 65.6

Black 95.2 56.0

Chart 4–4 

Death Rates for Total Lung Diseases by Age, Race, and Sex, U.S., 2006

In 2006, the male–female gap in mortality from total lung diseases mostly increased with increasing age for both 

blacks and whites.35

 Deaths/100,000 Population

Age 

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

35–44 16.1 6.1 13.6 5.9

45–54 36.7 19.5 33.6 17.4

55–64 82.4 66.5 79.0 56.8

65–74 219.3 242.2 182.4 200.6

75–84 641.0 716.6 371.3 516.3

Chart 4–5 

Prevalence of Chronic Obstructive Pulmonary Disease* by Age, U.S., 1997–2007

From 1997 through 2007, the prevalence of physician-diagnosed COPD decreased slightly for all age groups.24

 Percent of Population

Year

Ages 18–44 

Years

Ages 45–64 

Years Ages ≥65 Years

1997 4.3 7.1 10.6

1998 3.7 6.7 9.9

1999 3.9 6.1 9.5

2000 3.7 6.7 10.1

2001 4.6 7.7 10.5

2002 3.6 6.7 9.1

2003 3.1 6.0 9.4

2004 3.3 6.2 9.8

2005 3.4 6.2 9.6

2006 3.1 7.0 10.0

2007 2.4 5.8 8.6

* Physician-diagnosed COPD only.
67

Chart 4–6 

Prevalence of Chronic Obstructive Pulmonary Disease* by Age, Race, and Sex, U.S., 2007

In 2007, within racial groups, the prevalence of COPD was higher in females than in males, with one exception: 

In those aged 65 years and older, the prevalence was similar in males and females. Differences were observed 

between races: In males aged 45–64 years and in both males and females aged 65 years and older, the prevalence 

of COPD was higher in whites than in blacks.24

 Percent of Population

Age 

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

18–44 1.9 1.8 2.8 3.2

45–64 2.8 4.8 7.1 7.2

≥65 6.3 9.1 6.2 8.6

* Physician-diagnosed COPD only.

Chart 4–7 

Hospitalization Rates for Chronic Obstructive Pulmonary Disease, Ages 45–64 and 65 and Older, 

U.S., 1995–2006

Hospitalization rates for COPD were stable for those aged 45–64 years from 1995 to 2006 and for those aged 

65 years and older from 2000 through 2006.33, 34

 Hospitalizations/10,000 Population

Year Ages 45–64 Years Ages ≥65 Years

1995 28.6 110.6

1996 29.8 114.0

1997 30.8 123.8

1998 31.0 132.0

1999 32.7 139.9

2000 30.8 125.9

2001 28.4 130.0

2002 30.3 123.6

2003 28.0 125.0

2004 26.6 114.6

2005 28.2 125.8

2006 27.4 115.9
68

Chart 4–8 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Race and Sex, U.S., 

1960–2006

From 1960 to 1990, COPD mortality increased in white and black males, followed by a gradual turnaround and 

then a steep decline beginning in 1999. COPD mortality increased in white and black females until 1999 and then 

stabilized through 2006. The gaps between whites and blacks within sex groups continued throughout the 

period.15, 32, 36, 46

 Deaths/100,000 Population

Year

Black* 

Male

White 

Male

Black* 

Female

White

Female

1960 9.7 16.4 2.0 2.8

1961 10.1 17.4 2.3 2.9

1962 11.2 21.2 2.5 3.3

1963 14.2 26.0 2.9 4.1

1964 13.8 26.6 2.2 4.0

1965 15.6 30.7 2.3 4.7

1966 16.4 33.2 2.6 5.0

1967 18.1 33.6 3.2 5.2

1968 21.2 38.1 3.6 6.4

1969 22.5 37.3 3.6 6.6

1970 23.5 38.1 3.8 7.0

1971 23.5 40.8 5.2 7.5

1972 25.5 42.6 4.6 8.0

1973 25.5 44.8 4.4 8.9

1974 24.5 43.9 4.0 9.1

1975 24.7 44.9 4.7 9.5

1976 27.8 47.1 4.8 10.5

1977 27.5 46.4 5.2 10.8

1978 29.2 48.4 6.0 12.4

1979 27.9 46.2 5.3 12.0

1980 29.4 50.3 6.2 14.2

1981 32.2 50.7 6.6 15.2

1982 30.7 50.1 7.5 15.7

1983 34.1 53.3 8.1 17.7

1984 35.4 53.7 9.0 19.0

1985 37.5 56.1 9.9 20.9

1986 38.9 55.4 9.5 21.8

1987 37.8 54.4 10.8 22.5

1988 41.2 55.4 10.8 24.1

1989 40.4 53.5 12.7 25.2

1990 43.2 55.0 12.5 25.8

1991 41.5 55.1 13.2 27.2

1992 44.8 54.0 13.6 27.8

1993 44.8 57.1 14.8 31.0

1994 42.6 55.3 15.5 31.3

1995 42.5 54.7 15.6 31.4

1996 41.4 54.0 16.1 32.8

1997 41.3 54.4 16.0 33.5

1998 40.8 54.9 17.0 35.4

1999 48.0 59.0 19.3 38.0

2000 44.0 56.2 18.6 38.0

2001 43.1 54.6 18.6 38.3

2002 43.0 54.0 19.2 38.3

2003 41.5 52.9 18.7 39.0

2004 37.9 50.3 17.8 37.2

2005 41.4 52.1 19.5 39.4

2006 37.3 48.6 18.6 37.3

* Nonwhite from 1960 to 1967.
69

Chart 4–9 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Race/Ethnicity and 

Sex, U.S., 1999–2006

From 1999 to 2006, COPD mortality in males declined slightly in all racial/ethnic groups. In females, it declined 

slightly in Asians and Hispanics but was stable in non-Hispanic whites and non-Hispanic blacks. Within sex 

groups, COPD mortality was highest in whites.36

 Male (Deaths/100,000 Population)

Year Black* White* Hispanic Asian

1999 48.4 60.3 31.7 26.8

2000 44.4 57.9 27.3 26.0

2001 43.7 56.0 26.6 25.0

2002 43.5 55.5 26.2 23.5

2003 42.1 54.6 26.0 23.6

2004 38.5 52.0 22.9 20.8

2005 42.1 54.0 24.2 21.4

2006 37.7 50.5 21.2 21.1

 Female (Deaths/100,000 Population)

Year Black* White* Hispanic Asian

1999 19.7 39.2 15.5 10.2

2000 18.9 39.2 14.6 9.9

2001 18.7 39.6 14.8 9.5

2002 19.4 39.8 14.7 7.9

2003 18.9 40.7 14.4 8.4

2004 18.1 38.8 13.5 8.3

2005 19.8 41.2 14.3 8.3

2006 18.9 39.1 13.1 7.8

* Non-Hispanic.
70

Chart 4–10 

Death Rates for Chronic Obstructive Pulmonary Disease in White Males by Age, U.S., 1960–2006

In white males, the 1960–2006 death rates for COPD changed from an increasing to a declining trend. In 

successive age groups, the change occurred later but was increasingly prominent.15, 32, 36, 46

 Deaths/100,000 Population

Year

Ages 55–64

Years

Ages 65–74

Years

Ages 75–84

Years

Ages ≥85

Years

1960 36.1 82.8 101.8 111.2

1961 38.7 87.8 111.8 122.2

1962 44.2 107.2 136.7 154.8

1963 52.3 131.2 169.6 202.7

1964 51.8 131.6 181.9 202.3

1965 57.8 153.6 216.6 235.5

1966 61.9 161.9 244.8 258.5

1967 61.2 164.8 248.6 263.9

1968 67.3 186.7 286.5 307.8

1969 67.5 189.5 294.3 305.1

1970 68.1 196.5 311.5 280.9

1971 67.3 195.6 327.4 334.6

1972 67.7 204.8 351.4 354.8

1973 69.8 210.1 378.4 393.5

1974 64.8 204.8 380.4 379.8

1975 64.7 207.6 399.7 402.7

1976 64.0 210.7 419.7 482.8

1977 60.1 206.1 431.5 459.5

1978 60.1 213.2 430.1 515.7

1979 56.2 200.1 412.7 511.5

1980 58.1 213.2 450.3 601.1

1981 57.7 214.4 454.0 622.0

1982 55.2 205.9 462.6 616.1

1983 57.7 215.4 494.2 691.0

1984 58.8 212.7 493.9 724.4

1985 58.1 220.6 516.5 785.6

1986 57.5 216.1 513.3 772.9

1987 57.9 204.5 513.0 766.3

1988 58.6 210.7 512.0 814.6

1989 58.0 199.3 492.8 808.6

1990 56.4 203.1 503.6 830.9

1991 55.5 201.2 501.5 847.6

1992 54.2 199.2 486.3 839.1

1993 55.8 207.6 517.5 895.4

1994 53.8 200.2 496.5 886.5

1995 50.4 195.8 489.7 901.1

1996 49.5 192.1 484.6 902.9

1997 48.3 200.6 476.0 928.0

1998 47.5 201.9 481.8 914.9

1999 51.7 214.8 520.1 1,018.6

2000 47.4 198.9 498.9 966.0

2001 46.9 196.1 485.4 932.3

2002 44.8 190.4 490.6 912.9

2003 46.4 189.9 474.5 883.8

2004 42.9 178.8 459.6 827.4

2005 45.4 187.9 475.9 837.5

2006 42.1 170.2 450.1 779.5
71

Chart 4–11 

Death Rates for Chronic Obstructive Pulmonary Disease in Black* Males by Age, U.S., 1960–2006

In black males, the 1960–2006 death rates for COPD changed from an increasing to a declining trend. In 

successive age groups, the change occurred later but was increasingly prominent. 15, 32, 36, 46

 Deaths/100,000 Population

Year

Ages 55–64

Years

Ages 65–74

Years

Ages 75–84

Years

Ages ≥85

Years

1960 24.0 42.6 36.7 66.8

1961 23.0 43.0 49.7 66.6

1962 25.6 54.1 50.3 69.0

1963 31.8 62.4 68.5 131.1

1964 34.7 58.8 71.0 68.8

1965 34.8 61.8 93.8 132.3

1966 35.5 68.3 86.0 111.1

1967 36.9 75.1 104.9 128.2

1968 47.8 84.1 126.1 114.6

1969 50.9 93.0 133.5 145.5

1970 59.4 95.0 148.5 131.8

1971 52.9 99.8 135.5 155.1

1972 55.8 105.8 171.6 153.0

1973 56.6 109.6 153.4 188.7

1974 53.3 120.4 137.8 180.2

1975 51.5 103.4 170.3 156.3

1976 55.1 118.3 179.1 197.0

1977 56.7 120.3 174.5 204.1

1978 59.7 129.9 182.4 270.7

1979 51.0 123.9 195.4 269.5

1980 61.8 133.3 217.5 255.5

1981 56.8 141.5 244.7 262.5

1982 53.0 142.8 217.0 269.0

1983 65.2 147.5 263.2 333.3

1984 59.1 161.5 282.8 311.5

1985 61.8 168.1 311.7 366.1

1986 63.1 181.4 307.7 419.0

1987 57.7 176.2 314.2 425.0

1988 60.9 189.3 360.1 430.8

1989 59.9 180.0 359.3 463.6

1990 59.4 172.4 377.2 483.3

1991 57.5 173.7 347.4 472.5

1992 56.0 166.8 345.6 536.9

1993 56.7 175.6 392.2 545.8

1994 51.4 175.0 362.9 549.9

1995 53.9 166.6 357.0 589.6

1996 53.5 155.2 371.0 552.1

1997 46.7 168.3 366.8 549.1

1998 48.5 159.0 366.8 545.1

1999 53.9 175.5 426.1 683.2

2000 48.5 169.0 363.9 667.7

2001 45.2 161.2 371.7 656.9

2002 46.6 150.7 386.1 620.0

2003 46.3 149.8 373.5 582.9

2004 44.9 134.9 327.1 551.3

2005 45.0 151.8 364.9 587.5

2006 43.3 132.1 334.7 505.8

* Nonwhite from 1960 to 1967.
72

Chart 4–12 

Death Rates for Chronic Obstructive Pulmonary Disease in White Females by Age, U.S., 

1960–2006

From 1960 to 1990, death rates for COPD increased in all age groups of white females. Rates stabilized among 

those aged 55–64 years in the 1990s and among those aged 65 years and older in the 2000s.15, 32, 36, 46

 Deaths/100,000 Population

Year

Ages 55–64

Years

Ages 65–74

Years

Ages 75–84

Years

Ages ≥85

Years

1960 4.2 8.4 18.0 36.5

1961 4.4 9.2 18.8 37.9

1962 5.2 10.2 23.4 44.7

1963 6.1 12.5 26.7 54.1

1964 6.9 13.3 26.8 49.3

1965 8.0 16.0 29.8 53.8

1966 9.2 18.1 29.8 54.1

1967 10.2 18.0 31.4 58.0

1968 13.3 22.8 38.0 70.7

1969 13.3 24.3 39.3 74.5

1970 15.3 27.9 39.9 59.1

1971 15.5 29.8 45.5 66.8

1972 17.1 34.7 47.3 65.8

1973 18.8 37.6 53.4 80.7

1974 20.0 39.7 57.4 70.2

1975 21.5 41.9 58.7 74.0

1976 21.7 46.1 68.6 86.1

1977 22.1 49.6 70.5 91.1

1978 25.3 57.0 80.5 109.6

1979 23.8 55.0 80.8 107.0

1980 26.4 66.8 97.3 134.6

1981 27.4 72.4 107.6 134.9

1982 27.0 75.8 113.0 143.4

1983 29.9 85.5 129.1 164.2

1984 31.7 89.2 143.5 182.5

1985 34.4 95.5 162.5 205.0

1986 35.2 100.9 169.8 211.8

1987 35.7 102.2 177.8 233.3

1988 37.2 109.7 195.3 247.1

1989 40.1 111.7 204.6 262.0

1990 38.3 112.4 215.5 280.7

1991 41.1 120.1 225.7 289.8

1992 39.9 120.8 235.7 305.7

1993 43.6 136.4 263.1 339.0

1994 41.4 134.6 266.7 360.6

1995 40.3 132.7 268.1 377.1

1996 40.4 138.1 281.2 396.6

1997 41.0 138.7 288.1 415.9

1998 39.3 146.4 298.0 440.9

1999 43.2 155.9 333.0 529.7

2000 41.1 155.5 331.4 527.1

2001 42.0 156.7 331.0 557.9

2002 40.5 153.7 338.2 554.5

2003 40.9 155.5 345.7 546.9

2004 39.0 148.1 329.5 521.3

2005 40.1 153.4 351.1 568.2

2006 37.8 148.0 330.1 524.8
73

Chart 4–13 

Death Rates for Chronic Obstructive Pulmonary Disease in Black* Females by Age, U.S., 

1960–2006

From 1960 to 1990, death rates for COPD increased in black females of all age groups; however, rates before 

1980 for those aged 85 years and older were too erratic to discern a trend. Rates stabilized among those aged 

55–64 years in the 1990s and among those aged 65 years and older in the 2000s.15, 32, 36, 46

 Deaths/100,000 Population

Year

Ages 55–64

Years

Ages 65–74

Years

Ages 75–84

Years

Ages ≥85

Years

1960 2.8 5.1 7.2 29.8

1961 3.0 5.5 12.8 37.5

1962 4.3 6.0 14.6 22.5

1963 4.8 8.3 10.5 42.8

1964 4.0 3.6 8.3 24.4

1965 4.7 6.5 9.4 16.3

1966 5.3 8.6 10.9 18.9

1967 5.1 9.6 13.0 22.8

1968 8.1 8.2 17.1 36.0

1969 7.2 8.7 17.2 33.9

1970 8.6 11.9 17.4 26.7

1971 9.3 15.5 18.9 26.3

1972 8.4 14.0 22.1 46.4

1973 11.4 13.2 23.3 27.3

1974 9.5 16.9 18.4 25.8

1975 9.6 16.8 22.6 26.4

1976 12.8 17.3 21.5 30.6

1977 11.5 17.9 27.4 40.1

1978 16.1 17.5 31.3 60.6

1979 13.1 21.4 30.3 41.2

1980 15.8 25.4 34.4 60.5

1981 16.9 23.9 42.9 43.4

1982 19.6 30.0 43.8 52.5

1983 18.2 30.5 50.5 86.3

1984 20.7 35.9 56.1 89.9

1985 23.2 39.1 67.1 85.7

1986 22.4 41.7 59.0 85.5

1987 23.8 44.3 73.6 105.6

1988 24.6 46.2 66.8 100.7

1989 27.9 55.8 84.2 119.6

1990 25.2 54.4 84.3 122.4

1991 24.7 60.4 84.7 133.7

1992 22.7 62.1 91.2 142.3

1993 24.5 67.0 106.2 143.0

1994 26.1 67.1 106.3 175.8

1995 24.1 65.2 116.5 172.4

1996 23.7 71.8 116.0 193.6

1997 26.0 69.9 118.0 198.6

1998 25.0 73.1 129.3 208.5

1999 27.0 78.9 154.9 233.5

2000 27.8 72.7 145.8 234.0

2001 24.8 76.0 140.1 249.5

2002 24.5 73.6 158.8 249.7

2003 26.6 75.1 144.0 242.6

2004 22.5 69.2 149.2 224.9

2005 25.3 75.2 155.8 261.1

2006 23.5 69.1 154.7 243.1

* Nonwhite from 1960 to 1967.
74

Chart 4–14 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by State, U.S., 2003–2005

In 2003–2005, death rates for COPD tended to be highest in the Mountain States.15

Rank State Deaths/100,000 Population

1 Wyoming 58.9

2 Nevada 58.7

3 West Virginia 58.2

4 Oklahoma 58.0

5 Kentucky 57.4

6 Montana 56.1

7 Indiana 52.3

8 Colorado 51.8

9 Tennessee 51.7

10 Maine 51.2

11 Alabama 50.0

12 Ohio 49.4

13 Mississippi 49.3

14 Vermont 48.9

15 Kansas 48.9

16 Arkansas 48.8

17 Idaho 48.3

18 Oregon 47.3

19 Missouri 46.7

20 North Carolina 46.7

21 New Mexico 46.4

22 Georgia 46.2

23 Nebraska 45.8

24 Iowa 45.3

25 New Hampshire 45.0

26 South Carolina 44.9

27 Washington 44.7

28 South Dakota 44.2

29 Arizona 44.2

30 Michigan 43.1

31 Alaska 42.6

32 Texas 42.3

33 Delaware 42.1

34 Virginia 41.9

35 California 41.6

36 Louisiana 41.1

37 Wisconsin 39.7

38 Illinois 38.9

39 Florida 38.8

40 Pennsylvania 38.7

41 Rhode Island 38.4

42 Maryland 37.4

43 Massachusetts 36.8

44 Connecticut 36.2

45 Minnesota 36.1

46 North Dakota 36.1

47 Utah 34.1

48 New York 32.9

49 New Jersey 32.6

50 Hawaii 20.6
75

Chart 4–15 

Age-Adjusted Death Rates* for Chronic Obstructive Pulmonary Disease by Country and Sex, 

Ages 35–74, 2007

In 2006–2007, among 16 industrialized countries, the United States ranked second highest in COPD mortality for 

both males and females.45

 Deaths/100,000 Population

Country Male Female

Scotland 39.2 33.4

United States of America (2006)† 37.0 35.4

Romania 35.5 8.6

Denmark (2006)† 32.2 38.0

Poland (2006)† 30.5 7.5

England and Wales 29.4 22.0

Norway (2006)† 26.3 21.9

Czech Republic 25.7 8.5

Netherlands 23.9 17.5

Finland 21.5 5.7

Germany (2006)† 21.0 9.5

Republic of Korea (2006)† 14.9 2.8

Sweden (2006)† 13.9 14.0

Italy (2006)† 12.8 4.0

France (2006)† 9.4 2.2

Japan 4.5 0.8

* Age-adjusted to European standard.

†

 Data for 2006.

Chart 4–16 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease by Race/Ethnicity and 

Sex, U.S., 2006

In 2006, COPD mortality was 35% higher in males than in females. Within sex groups, it was highest among 

non-Hispanic whites and lowest among Asians. COPD mortality in Hispanic males was similar to that of Asian 

males.35

 Deaths/100,000 Population

Race/Ethnicity Male Female

Total 46.7 34.6

White* 50.5 39.1

Black* 37.7 18.8

Hispanic 21.2 13.1

Asian 21.1 7.8

* Non-Hispanic.
76

Chart 4–17 

Death Rates for Chronic Obstructive Pulmonary Disease by Age, Race, and Sex, U.S., 2006

In 2006, COPD mortality increased with age for all racial and sex groups. Within age groups was highest in white 

males aged 65 years and older and lowest in black females aged 45 years and older.35

 Deaths/100,000 Population

Age

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

35–44 1.53 1.08 1.52 1.04

45–54 9.80 8.39 6.52 7.84

55–64 43.26 42.13 23.49 37.76

65–74 132.07 170.21 69.08 148.02

75–84 334.73 450.11 154.65 330.09

Chart 4–18 

Prevalence of Asthma Ages Younger Than 18 and 18 and Older, U.S., 1980–2007

The prevalence of asthma during a given 12-month period (for 1980–1996) and the lifetime prevalence of asthma 

(for 1997–2007) rose in both age groups, while trends in asthma attack prevalence (for 1997–2006) and current 

prevalence (for 2001–2007) were relatively stable. All prevalence measures were higher in the younger group 

than in the older group.26–28

 12-Month Period Prevalence Lifetime Prevalence Attack Prevalence Current Prevalence

Year

Ages <18 

Years

Ages ≥18 

Years

Ages <18 

Years

Ages ≥18 

Years

Ages <18 

Years

Ages ≥18 

Years

Ages <18 

Years

Ages ≥18 

Years

1980 3.6 3.0 — — — — — —

1981 3.8 3.2 — — — — — —

1982 4.0 3.3 — — — — — —

1983 4.5 3.6 — — — — — —

1984 4.3 3.4 — — — — — —

1985 4.8 3.3 — — — — — —

1986 5.1 3.7 — — — — — —

1987 5.3 3.6 — — — — — —

1988 5.0 3.8 — — — — — —

1989 6.1 4.3 — — — — — —

1990 5.7 3.6 — — — — — —

1991 6.3 4.2 — — — — — —

1992 6.3 4.4 — — — — — —

1993 7.2 4.4 — — — — — —

1994 6.9 5.1 — — — — — —

1995 7.5 5.0 — — — — — —

1996 6.2 5.3 — — — — — —

1997 — — 11.4 9.1 5.4 3.7 — —

1998 — — 12.1 9.0 5.3 3.4 — —

1999 — — 10.8 8.5 5.3 3.4 — —

2000 — — 12.4 9.3 5.5 3.5 — —

2001 — — 12.7 10.9 5.7 3.8 8.7 6.9

2002 — — 12.2 10.7 5.8 3.7 8.3 6.8

2003 — — 12.5 9.7 5.4 3.3 8.5 6.4

2004 — — 12.2 9.9 5.4 3.6 8.5 6.7

2005 — — 12.7 10.7 5.2 3.9 8.9 7.2

2006 — — 13.5 11.0 5.9 3.8 9.3 7.3

2007 — — 13.1 10.9 — — 9.1 7.3
77

Chart 4–19 

Prevalence of Asthma by Race, U.S., 1980–2007

The prevalence of asthma during a given 12-month period (for 1980–1996) and lifetime prevalence of asthma (for 

1997–2007) rose in black and whites, but asthma attack prevalence (for 1997–2006) and current prevalence (for 

2001–2007) were more stable. Measures of prevalence were generally higher in blacks than in whites.26–28

 12-Month Period Prevalence Lifetime Prevalence Attack Prevalence Current Prevalence

Year Black* White* Black* White* Black* White* Black* White*

1980 3.37 3.09 — — — — — —

1981 3.60 3.20 — — — — — —

1982 3.92 3.46 — — — — — —

1983 4.51 3.77 — — — — — —

1984 3.48 3.69 — — — — — —

1985 3.97 3.73 — — — — — —

1986 4.25 4.09 — — — — — —

1987 4.43 4.02 — — — — — —

1988 5.55 3.99 — — — — — —

1989 5.31 4.71 — — — — — —

1990 4.66 4.13 — — — — — —

1991 5.63 4.64 — — — — — —

1992 5.68 4.92 — — — — — —

1993 6.14 5.02 — — — — — —

1994 5.63 5.62 — — — — — —

1995 6.70 5.62 — — — — — —

1996 6.96 5.34 — — — — — —

1997 — — 4.60 4.10 10.70 9.70 — —

1998 — — 4.70 3.80 12.47 9.74 — —

1999 — — 4.20 3.80 10.26 9.12 — —

2000 — — 4.40 3.90 11.56 10.22 — —

2001 — — 5.20 4.20 12.50 11.50 8.3 7.5

2002 — — 5.40 4.10 13.80 11.10 9.6 7.3

2003 — — 4.90 3.70 12.90 10.40 9.2 6.9

2004 — — 5.20 4.00 13.20 10.60 9.4 7.3

2005 — — 4.55 4.12 13.50 11.30 9.9 7.6

2006 — — 4.53 4.17 13.50 11.80 9.2 7.9

2007 — — 5.07 4.02 — — — —

* Non-Hispanic.

Chart 4–20 

Prevalence of Current Asthma by Race/Ethnicity and Sex, Ages Younger Than 18, U.S., 2006

In 2006, among children younger than 18 years of age, the prevalence of current asthma was higher in males than 

in females. Within sex groups, the prevalence of current asthma was higher in non-Hispanic blacks than in nonHispanic whites and Hispanics.26–28

 Percent of Population

Race/Ethnicity Male Female

Total 11.0 7.5

Black* 14.2 11.2

White* 10.2 7.2

Hispanic 11.8 6.1

* Non-Hispanic.
78

Chart 4–21 

Prevalence of Current Asthma by Race/Ethnicity and Sex, Ages 18 and Older, U.S., 2006

In 2006, among adults aged 18 years and older, the prevalence of current asthma was higher in females than in 

males. Within sex groups, the prevalence of current asthma was higher in non-Hispanic blacks and non-Hispanic 

whites than in Hispanics.26–28

 Percent of Population

Race/Ethnicity Male Female

Total 5.6 8.9

Black* 5.4 9.5

White* 6.1 9.2

Hispanic 2.9 7.4

* Non-Hispanic.

Chart 4–22 

Physician Office Visits for Asthma, U.S., 1990–2006

From 1990 to 2006, the number of physician office visits for asthma was erratic with no obvious trend.44

Year Physician Office Visits (Millions)

1990 7.1

1991 8.8

1992 9.7

1993 11.3

1994 10.8

1995 9.0

1996 9.0

1997 9.8

1998 12.9

1999 9.5

2000 9.3

2001 11.3

2002 12.7

2003 12.8

2004 13.6

2005 12.8

2006 10.6
79

Chart 4–23 

Hospitalizations for Asthma by Primary and Secondary Diagnosis, U.S., 1980–2006

From 1980 to 2006, the number of hospitalizations with asthma as the primary diagnosis remained relatively 

stable. However, the number of hospitalizations with asthma as a secondary diagnosis increased significantly.33, 34

 Hospitalizations (Thousands)

Year

Primary 

Diagnosis

Secondary

Diagnosis

1980 379 192

1981 418 210

1982 434 230

1983 459 250

1984 465 274

1985 462 281

1986 477 303

1987 454 331

1988 479 349

1989 475 360

1990 476 385

1991 490 433

1992 463 493

1993 468 532

1994 451 602

1995 511 665

1996 474 709

1997 484 758

1998 423 833

1999 479 869

2000 465 926

2001 454 1,032

2002 484 1,002

2003 574 1,268

2004 497 1,373

2005 489 1,439

2006 444 1,467
80

Chart 4–24 

Hospitalizations for Asthma by Age, U.S., 1980–2006

From 1980 to 2006, hospitalization rates for asthma were lowest among those aged 15–44 years. From 1991 to 

2004, hospitalization rates for asthma were highest among those aged younger than 15 years.33, 34

 Hospitalizations/10,000 Population

Year

Ages <15

Years

Ages 15–44

Years

Ages 45–64

Years

Ages ≥65

Years

1980 24.3 9.5 22.9 34.5

1981 25.0 10.6 23.3 28.3

1982 29.3 9.7 22.1 30.4

1983 26.4 10.1 26.7 34.2

1984 28.9 9.9 22.8 37.3

1985 27.8 11.1 21.5 34.1

1986 30.3 10.8 22.0 33.7

1987 28.4 9.7 20.4 33.8

1988 30.9 9.6 20.2 31.0

1989 31.2 11.0 18.9 30.0

1990 30.8 10.3 18.3 32.3

1991 33.9 10.9 18.2 28.5

1992 34.6 9.9 16.5 23.7

1993 28.0 10.9 19.0 26.6

1994 29.5 10.7 15.8 23.0

1995 36.7 11.4 16.7 23.0

1996 33.8 11.1 16.4 17.4

1997 35.8 9.6 15.9 19.2

1998 27.7 8.6 16.2 17.7

1999 31.5 10.0 15.9 21.2

2000 34.7 9.2 13.7 19.5

2001 30.1 8.4 14.3 21.5

2002 30.8 8.8 16.4 22.5

2003 35.0 10.2 18.3 30.5

2004 31.2 7.3 15.9 28.7

2005 26.2 7.8 16.3 30.4

2006 23.9 7.1 16.1 23.6

Chart 4–25 

Age-Adjusted Death Rates for Asthma by Race and Sex, U.S., 2006

In 2006, asthma mortality in males was 2–3.5 times higher in non-Hispanic blacks than in all other racial/ethnic 

groups. In females, asthma mortality was more than 2 times higher in non-Hispanic blacks than in all other racial/

ethnic groups. Overall, asthma mortality was 44% higher in females than in males.31

 Deaths/100,000 Population

Race Male Female

Total 0.9 1.3

Black* 2.6 2.9

White* 0.7 1.1

Hispanic 0.7 1.2

Asian 1.2 1.3

* Non-Hispanic.
81

Chart 4–26 

Age-Adjusted Death Rates for Asthma by Race and Sex, Ages 1–24, U.S., 1980–2006

From 1980 through 1998, death rates for asthma, although erratic, tended to rise in black and white males and 

females aged 1–24 years. From 2001 to 2006, asthma mortality continued to fluctuate in black males and females 

but was stable in white males and females.15, 35

 Deaths/100,000 Population

Year

Black 

Male

White 

Male

Black 

Female

White 

Female

1980 1.03 0.18 0.57 0.14

1981 1.17 0.20 0.48 0.22

1982 1.49 0.27 0.64 0.27

1983 1.41 0.18 0.56 0.27

1984 0.97 0.20 0.56 0.22

1985 1.53 0.20 0.83 0.28

1986 1.44 0.28 0.68 0.28

1987 1.61 0.28 0.77 0.28

1988 1.67 0.28 0.75 0.31

1989 1.59 0.32 0.62 0.31

1990 1.57 0.32 0.61 0.28

1991 1.83 0.32 0.84 0.37

1992 1.83 0.31 0.93 0.31

1993 1.75 0.33 0.81 0.37

1994 2.49 0.40 0.95 0.39

1995 2.30 0.41 0.82 0.49

1996 1.77 0.34 1.01 0.43

1997 1.96 0.44 0.77 0.33

1998 2.37 0.29 0.92 0.33

1999 1.36 0.27 0.66 0.20

2000 1.28 0.23 0.80 0.19

2001 1.13 0.18 0.88 0.15

2002 1.30 0.19 0.64 0.16

2003 1.31 0.20 0.69 0.16

2004 1.15 0.20 0.55 0.16

2005 1.24 0.16 0.65 0.11

2006 1.21 0.16 0.65 0.09
82

Chart 4–27 

Age-Adjusted Death Rates for Asthma by Race and Sex, U.S., 1980–2006

From 1980 to the mid-1990s, death rates for asthma rose in blacks and whites, both male and female, but then 

declined through 2006. Within sex groups, blacks had higher asthma mortality rates than whites.15, 35 

 Deaths/100,000 Population

Year

Black 

Male

White 

Male

Black 

Female

White 

Female

1980 2.90 1.32 2.64 1.26

1981 3.00 1.27 2.60 1.38

1982 2.96 1.23 2.99 1.37

1983 3.37 1.36 3.35 1.54

1984 3.25 1.37 3.22 1.50

1985 3.66 1.41 3.31 1.69

1986 3.47 1.43 3.77 1.63

1987 4.18 1.46 3.92 1.84

1988 4.48 1.53 4.35 1.87

1989 4.24 1.57 4.30 2.03

1990 4.39 1.58 4.06 1.97

1991 4.25 1.55 4.23 2.09

1992 3.95 1.50 4.43 1.98

1993 4.09 1.52 4.61 2.00

1994 4.43 1.58 4.63 2.09

1995 4.50 1.54 4.85 2.19

1996 4.39 1.48 5.20 2.09

1997 4.03 1.43 4.54 2.01

1998 4.09 1.33 4.76 1.95

1999 3.53 1.02 4.09 1.68

2000 3.50 1.02 4.12 1.51

2001 3.23 0.89 3.82 1.46

2002 3.32 0.94 3.43 1.41

2003 2.91 0.88 3.31 1.67

2004 3.00 0.76 3.07 1.23

2005 2.68 0.74 3.28 1.25

2006 2.53 0.80 2.81 1.13
83

Chart 4–28 

Death Rates for Asthma by Age, Race, and Sex, U.S., 1999–2006

In 1999–2006, among blacks, asthma mortality was higher in males than in females aged 1–34 years, but was 

higher in females than in males aged 35–84 years. Among whites, asthma mortality was slightly higher in males 

than in females aged 1–24 years, but was higher in females than in males aged 25–84 years.15

 Deaths/100,000 Population

Age

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

1–4 1.07 0.13 0.35 0.09

5–9 0.83 0.12 0.52 0.09

10–14 1.45 0.22 0.81 0.14

15–19 1.45 0.24 0.67 0.18

20–24 1.47 0.30 1.06 0.24

25–34 2.22 0.36 1.41 0.41

35–44 2.66 0.53 3.01 0.82

45–54 3.73 0.78 5.44 1.36

55–64 4.94 1.04 6.74 1.94

65–74 6.47 1.90 8.11 3.34

75–84 7.84 4.00 9.85 6.79

Chart 4–29 

Age-Adjusted Death Rates* for Asthma by Country and Sex, 2007

In 2006–2007, among 15 countries, the United States ranked ninth for males and fourth for females for asthma 

mortality.45

 Deaths/100,000 Population

Country Male Female

Poland (2006)† 1.89 1.03

Germany (2006)† 1.42 1.17

Romania 1.40 1.09

Scotland 1.16 1.71

Denmark (2006)† 1.07 1.24

England and Wales 1.03 1.51

Norway (2006)† 1.03 1.66

France (2006)† 0.99 1.10

Finland 0.94 1.32

United States of America (2006)† 0.94 1.34

Czech Republic 0.83 0.82

Sweden (2006)† 0.62 1.13

Japan 0.48 0.28

Italy (2006)† 0.46 0.44

Netherlands 0.23 0.33

* Age-adjusted to European standard.

†

 Data for 2006.
84

Chart 4–30 

Infant Mortality Rate for Respiratory Distress Syndrome, U.S., 1968–2006

Infant mortality for RDS declined steeply from 1974 to 1981, followed by a slow but appreciable decline through 

2006.31, 32

Year Deaths/100,000 Live Births

1968 236.2

1969 247.9

1970 261.6

1971 267.6

1972 274.8

1973 277.8

1974 263.4

1975 248.0

1976 222.9

1977 198.3

1978 179.7

1979 156.2

1980 138.1

1981 119.0

1982 109.7

1983 101.2

1984 96.9

1985 98.2

1986 90.6

1987 86.2

1988 81.4

1989 89.9

1990 68.5

1991 62.5

1992 50.8

1993 45.4

1994 39.6

1995 37.3

1996 35.0

1997 33.5

1998 32.9

1999 27.3

2000 24.4

2001 25.1

2002 23.4

2003 20.3

2004 21.3

2005 20.8

2006 19.3
85

Chart 4–31 

Infant Mortality Rate for Respiratory Distress Syndrome by Race, U.S., 1980–2006

From 1980 to 2006, infant mortality for RDS decreased appreciably in blacks and whites, with rates remaining 

higher in blacks.31, 32

 Deaths/100,000 Live Births

Year Black White

1980 187.9 125.8

1981 178.6 109.8

1982 171.3 100.3

1983 159.4 92.0

1984 149.1 89.3

1985 149.8 90.5

1986 144.2 81.5

1987 145.6 76.5

1988 142.4 70.5

1989 172.2 74.7

1990 143.8 54.6

1991 131.6 50.0

1992 143.3 41.3

1993 104.1 34.9

1994 83.4 32.1

1995 82.7 29.4

1996 79.5 27.3

1997 74.2 26.7

1998 73.9 27.6

1999 61.9 21.5

2000 55.7 19.6

2001 58.2 19.8

2002 56.9 18.4

2003 43.7 16.8

2004 49.4 17.3

2005 46.6 16.5

2006 41.9 15.5
86

Chart 4–32 

Infant Mortality Rate for Respiratory Distress Syndrome by Race/Ethnicity,* U.S., 2005

In 2005, infant mortality for neonatal RDS was much higher in blacks than in any other racial/ethnic group. 

Mortality for neonatal RDS in Mexican Americans was the lowest among all racial/ethnic groups.47

 Deaths/100,000 Live Births

All 20.8

Black 47.1

Hispanic 16.3

Central and South American 20.6

White† 16.6

Mexican-American 13.4

Asian Pacific Islanders 15.1

* No data for American Indians and Puerto Ricans.

† Non-Hispanic.

Chart 4–33 

Infant Mortality Rate for Sudden Infant Death Syndrome by Race/Ethnicity, U.S., 2005

In 2005, mortality for SIDS was highest in American Indians and lowest in Asian Pacific Islanders.48

 Deaths/100,000 Live Births

All 54.0

American Indian 111.6

Black 99.4

White† 55.4

Puerto Rican 39.5

Mexican-American 28.6

Hispanic 28.1

Asian Pacific Islanders 23.8

* No data for Central and South Americans.

† Non-Hispanic.
87

5. Blood Diseases 

The term blood diseases is used here to mean diseases within the diagnostic categories listed in Diseases of the 

Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism of the ICD-10; 

hemochromatosis is also included in this chapter. Blood-clotting diseases, most of which are subsumed under 

CVD, have been excluded, as have other blood diseases such as bleeding and red blood disorders of the newborn 

and serum hepatitis.

Chart 5–1 shows the distribution of deaths in 2006 by blood disease subgroups.35 For blood diseases, Chart 5–2 

shows according to ICD-9-CM codes, the number of physician office visits, the number of hospitalizations, and 

length of hospital stay in 2006, and according to ICD-10 codes, the number of deaths in 2006.34, 35, 44

Subsequent charts display morbidity and mortality for aplastic anemia and sickle cell anemia. The annual death 

rates for these diseases are small and may vary considerably from year to year. By using combined mortality over 

4 to 5 years to obtain average annual death rates rather than statistics for a single year, it is possible to improve 

data reliability for race and sex comparisons.

Chart 5–1 

Blood Disease Deaths, Percent by Subgroup, U.S., 2006

Blood Diseases Percent

Other anemias 29.0

Other diseases of blood and blood-forming organs 20.4

Coagulation defects 19.1

Aplastic anemia 10.0

Purpura and other hemorrhagic conditions 9.1

Sickle cell anemia 5.2

Diseases of white blood cells 4.9

Hemochromatosis 2.4

Total Deaths = 9,050 (100%)
88

Chart 5–2 

Number of Hospitalizations, Physician Office Visits,* and Deaths for Blood Diseases, U.S., 2006

 Hospitalizations 

Diagnostic Category ICD-9-CM Codes

First-Listed 

Discharges 

(1,000)

Length 

of Stay 

(Days)

Physician Office

Visits (1,000) ICD-10 Codes Deaths

Total 280–289, 275 465 4.3 5,503 D50–D89, E83.1 9,050

Anemias 280–285 312 4.0 3,855 D50–D64 3,996

Iron deficiency anemia 280 94 3.5 451 D50 161

Other deficiency anemia 281 — — 382 D51, D52 53

Cooley’s anemia 282.4 9 3.9 7 D56 21

Sickle cell anemia 282.6 57 4.9 104 D57.0, D57.1 473

Aplastic anemia 284 28 5.9 247 D60, D61 901

Other and unspecified anemias Residual 124 3.6 2,663 Residual 2,387

Coagulation defects 286 13 5.2 113 D65–D68 1,725

Hemophilia: Factor VIII 286.0 — — — D66 59

Hemophilia: Factor IX 286.1 — — 13 D67 3

Other Residual 13 5.2 100 Residual 1,706

Purpura and other hemorrhagic conditions 287 35 5.0 490 D69 822

Primary thrombocytopenia 287.3 15 4.7 133 D69.3, D69.4 326

Unspecified thrombocytopenia 287.4 — — — D69.5, D69.6 457

Other Residual 20 5.3 357 Residual 39

Diseases of white blood cells 288 66 5.0 253 D70–D72 447

Other diseases of blood and blood-forming organs 289 22 4.0 378 D73–D89 1,844

Hemochromatosis 275 17 4.6 414 E83.1 216

* Estimates of hospitalizations and physician office visits are subject to sampling variability. Estimates of hospitalizations below 15,000 

have a relative standard error of more than 16%. Estimates of physician office visits below 1 million have a relative standard error of more 

than 30%.
89

Chart 5–3

Hospitalizations for Aplastic Anemia by Primary and Secondary Diagnosis, U.S., 1982–2006

In 2006, the number of hospitalizations for aplastic anemia as a primary diagnosis was 56% higher than it was in 

1990; as a secondary diagnosis it was 100% higher in 2006 than in 1990.33, 34

 Number (Thousands)

Year

Primary 

Diagnosis

Secondary

Diagnosis

1982 18 29

1983 20 38

1984 20 41

1985 16 45

1986 18 46

1987 19 63

1988 14 81

1989 15 73

1990 18 86

1991 24 93

1992 23 124

1993 25 119

1994 20 113

1995 23 130

1996 23 146

1997 23 134

1998 28 143

1999 32 151

2000 28 140

2001 28 141

2002 29 154

2003 35 158

2004 29 176

2005 30 179

2006 28 171

Chart 5–4 

Age-Adjusted Death Rates* for Aplastic Anemia by Race and Sex, U.S., 2003–2006

In 2003–2006, mortality from aplastic anemia within sex groups was slightly higher in blacks than in whites. 

Overall, it was approximately 20% higher in males than in females.15

 Deaths/100,000 Population

Race Male Female

Total 0.35 0.29

White 0.35 0.28

Black 0.37 0.31

* Average annual rates.
90

Chart 5–5 

Death Rates* for Aplastic Anemia by Age, Race, and Sex, U.S., 2003–2006

In 2003–2006, mortality from aplastic anemia within sex groups was slightly higher in blacks than in whites, 

except those in the 75–84 age group. Within racial groups, it was higher in males than in females for blacks at all 

ages and for white males aged 65 years and older.15

 Deaths/100,000 Population

Age

(Years)

Black 

Male

White 

Male

Black 

Female

White 

Female

35–44 0.13 0.06 0.12 0.06

45–54 0.19 0.12 0.14 0.11

55–64 0.38 0.28 0.35 0.32

65–74 1.23 0.96 0.78 0.74

75–84 2.35 2.46 1.68 1.85

* Average annual rates.

Chart 5–6 

Hospitalization Rates for Sickle Cell Anemia in Blacks, Ages Younger Than 15 and 15–44, U.S., 

1982–2006

Hospitalization rates for sickle cell anemia in blacks varied considerably between 1982 and 2006. Overall, 

however, hospitalization rates increased for both age groups, with rates in the 15–44 age group remaining higher 

than those in the younger than 15 age group.33, 34

 Hospitalizations/10,000 Population

Year Ages <15 Years Ages 15–44 Years

1982 11.7 21.0

1983 12.9 20.6

1984 14.2 21.6

1985 12.8 17.8

1986 17.9 21.6

1987 16.5 21.2

1988 18.8 20.3

1989 25.0 22.7

1990 26.6 23.8

1991 21.0 24.1

1992 19.6 20.6

1993 15.9 22.2

1994 13.5 27.7

1995 22.2 26.2

1996 15.6 24.7

1997 18.9 25.6

1998 15.6 27.8

1999 16.6 25.2

2000 21.0 25.4

2001 19.1 30.1

2002 26.0 29.2

2003 16.0 30.8

2004 16.0 31.8

2005 28.0 38.4

2006 17.0 31.9
91

Chart 5–7

Age-Adjusted Death Rates* for Sickle Cell Anemia in Blacks by Sex, U.S., 1980–1984 to 2003–2006

From 1980–1984 to 1990–1994, sickle cell anemia mortality rose for black males and females. Since then, death 

rates have stabilized for black women, but declined for black males through 1999–2002 before stabilizing through 

2003–2006.15

 Deaths/100,000 Population

Year Male Female

1980–1984 1.22 0.92

1985–1989 1.30 1.03

1990–1994 1.48 1.26

1995–1998 1.43 1.26

1999–2002 1.33 1.26

2003–2006 1.30 1.20

* Average annual rates.

Chart 5–8 

Death Rates* for Sickle Cell Anemia in Blacks by Age and Sex, U.S., 2003–2006

In 2003–2006, sickle cell anemia mortality was somewhat similar in males and females at all ages. Death rates 

were relatively high for individuals aged 25–64 years.15

 Deaths/100,000 Population

Age (Years) Black Male Black Female

1–4 0.51 0.31

5–14 0.21 0.23

15–24 1.07 0.95

25–34 2.13 1.75

35–44 2.25 1.85

45–54 1.72 2.06

55–64 1.58 1.45

65–74 0.51 0.95

75–84 0.48 0.16

* Average annual rates. 
92

Appendixes

A. International Classification of Diseases

B. Estimated Comparability Ratios

C. Definition of Terms

D. Abbreviations

E. References
93

Appendix A

International Classification of Diseases: 

Codes for Selected Diagnostic Categories 

(6th, 7th, 8th, 9th, and 10th Revisions)

Diagnostic Term in Chart Book

ICD-6 

1949–1957

ICD-7 

1958–1967

ICDA-8 

1968–1978

ICD-9 

1979–1998

ICD-10 

1999–

Cardiovascular diseasesa 330–334, 400–468 330–334, 400–468 390–458 390–459 I00–I99

Heart disease 400–402, 410–443 400–402, 410–443 390–398 390–398, 402, 

404–429

I00–I09, I11, I13, 

I20–I51

Coronary heart diseaseb 420, 422 420, 422 410–413 410–414, 429.2 I20–I25

Acute myocardial infarction * * 410 410 I21, I22

Heart failurec † † 427.0, 427.1 428 I50

Congestive heart failure † † 427.0 428 I50.1

Cardiomyopathy † † † 425 I42

Cerebrovascular disease (stroke)d 330–334 330–334 430–438 430–438 I60–I69

Diseases of arteries 450–456 450–456 440–448 440–448 I70–I78

Congenital anomalies of the circulatory systeme † † 746–747 745–747 Q20–Q28

Chronic obstructive pulmonary diseasef 500–502, 527.1 500–502, 527.1 490–492, 519.3 490–492, 494–496 J40–J44, J47

Asthmag 241 241 493 493 J45, J46

Neonatal respiratory distress syndromeh † † 776.1, 776.2 769 P22

Sudden infant death syndrome † † † † R95

a

 The ICD term is diseases of the circulatory system.

b

 The ICD-6 and ICD-7 term is arteriosclerotic heart disease; the ICDA-8, ICD-9, and ICD-10 term is ischemic heart disease.

c

 The ICDA-8 terms are congestive heart failure and left ventricular failure. The ICD-9 and ICD-10 term is heart failure.

d

 The ICD-6 and ICD-7 term is vascular diseases affecting the central nervous system; the ICDA-8, ICD-9, and ICD-10 term is 

cerebrovascular disease.

e

 The ICDA-8 terms are congenital anomalies of heart and other congenital anomalies of circulatory system. The ICD-9 terms are bulbus 

cordis anomalies and anomalies of cardiac septal closure, other congenital anomalies of heart, and other congenital anomalies of circulatory 

system. The ICD-10 term is congenital malformations of the cardiovascular system.

f

 The ICD-6 and ICD-7 terms are chronic bronchitis, unqualified bronchitis, and emphysema without mention of bronchitis; the ICDA-8 

terms are chronic bronchitis, unqualified bronchitis, emphysema, and chronic obstructive lung disease; the ICD-9 and ICD-10 terms are 

chronic bronchitis, bronchitis not specified as acute or chronic, emphysema, bronchiectasis, extrinsic allergic alveolitis, and chronic airways 

obstruction not elsewhere classified. 

g

 The ICD-6 through ICD-9 term is asthma; the ICD-10 terms are asthma and status asthmaticus.

h

 The ICDA-8 terms are hyaline membrane disease and respiratory distress syndrome. The ICD-9 term is respiratory distress syndrome. The 

ICD-10 is respiratory distress of newborns.

*

 No code for this category exists in this ICD revision.

†

 No data for this category are presented in the Chart Book in this period.
94

Appendix B

Estimated Comparability Ratios for 

Selected Causes of Death, U.S. 

 Codes of the Classification of International Diseases Number of Deaths* 

Cause of Death ICD-10 ICD-9 ICD-10 ICD-9

Comparability 

Ratio†

Major cardiovascular diseases I00–I78 390–434, 436–448 942,439 945,945 0.9963

Diseases of the heart I00–I09, I11, I13, 120–I51 390–398, 402, 404, 410–429 719, 631 730,444 0.9852

Coronary heart disease I20–I25 410-414, 429.2 543, 063 542,728 1.0006

Heart failure I50 428 48,876 47,052 1.0388

Cerebrovascular Disease (stroke) I60–I69 430–434, 436–438 166,837 158,855 1.0502

COPD J40–J44 490–492, 494, 496 104,775 99,797 1.0499

Asthma J45–J46 493 4,971 5,614 0.8855

Neonatal RDS‡ P22 769 2,904 3,144 0.9237

* From a sample of deaths in 1996.8

†

 Deaths coded to ICD-10 divided by deaths coded to ICD-9.

‡

 Infant deaths.
95

Appendix C

Definition of Terms

Age-adjusted death rate: An age-adjusted rate is a summary rate for a given age range and is computed 

by multiplying the age-specific rates for a given diagnosis (or cause of death) 

by the standard population for the age range and summing those products. 

The standard population is the U.S. population in 2000 as it is distributed 

proportionately in 10-year age groups.10

Any mention mortality: A count of death certificates for a given cause of death that was selected as 

either the underlying cause or otherwise mentioned on the death certificate.36

Chronic condition: A condition is considered chronic if (1) the respondent (in a health interview) 

indicates the condition was first noticed more than 3 months before the initial 

date of the interview or (2) the type of condition ordinarily has a duration of 

more than 3 months.37

Comparability ratio: A comparability ratio is the number of deaths from a cause as coded by an 

ICD revision divided by the number of deaths from the closest similar cause 

as coded by the proceeding ICD revision. A sample of death certificates from 

a chosen year is used for the calculation. The ratios measure discontinuities in 

mortality trends that result from the introduction of a new ICD revision.8

Hospitalization: Hospitalization refers to hospital discharge—that is, the formal release of a 

hospital inpatient. Hospital discharge may be the result of death or transfer to 

a place of residence, nursing home, or another hospital. First-listed diagnosis is the coded diagnosis identified as the primary diagnosis or the diagnosis 

first listed on the face sheet of the hospital medical record. Hospital refers to 

non-Federal, short-stay (average length of patient’s stay is less than 30 days), 

general (e.g., medical or surgical), or children’s general hospitals, with six or 

more beds for inpatient use.37

Incidence: Incidence is the number of cases with onset during a specified period of time, 

usually a year.37

Infant mortality rate: Infant mortality is the number of deaths occurring in infants younger than 1 

year of age from a cause (or all causes) divided by the number of live births 

occurring the same year, and then expressed as the rate per 100,000 live births 

for that year.37

Limited in activity: Also called chronic activity limitation, it refers to the limitation of a person’s 

usual activity due to a chronic condition.37

Morbidity: Morbidity refers to incidence, prevalence, hospitalizations, and physician 

office visits.
96

Appendix C

Definition of Terms (continued)

Prevalence: The prevalence of a condition is the number of persons who have the condition at a given time.37

Relative standard: The standard error is primarily a measure of sampling error—not

error: measurement error—that is, the variation that might occur by chance because 

only a sample of the population is surveyed. The relative standard error of 

an estimate is obtained by dividing the standard error of the estimate by the 

actual estimate.37

Underlying cause The underlying cause of death is the disease or injury that initiated the

of death: events leading directly to death. Underlying cause of death is selected from 

the cause(s) or condition(s) entered in the cause-of-death section of the death 

certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the 

certificate, provisions of the ICD, and rules of associated classifications.37
97

Appendix D

Abbreviations*

AMI acute myocardial infarction

BP blood pressure

CHD coronary heart disease

CM clinical modification

CMS Centers for Medicare & Medicaid Services

COPD chronic obstructive pulmonary disease

CVD cardiovascular diseases

HF heart failure

ICD International Classification of Diseases

NCHS National Center for Health Services

NHANES National Health and Nutrition Examination Survey

NHDS National Hospital Discharge Survey

NHIS National Health Interview Survey

NHLBI National Heart, Lung, and Blood Institute

RDS respiratory distress syndrome

SIDS sudden infant death syndrome

WHO World Health Organization

*Country abbreviations are listed on the next page.
98

Appendix D

Abbreviations (continued)

CZR Czech Republic

DEN Denmark

EW England/Wales

FIN Finland

FRA France

GER Germany

ITA Italy

JPN Japan

KOR Republic of Korea

NOR Norway

NTH Netherlands

POL Poland

ROM Romania

SCO Scotland

SWE Sweden

USA United States of America
99

Appendix E

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6. Rosenberg HM, Maurer JD, Sorlie RD, et al. Quality of Death Rates by Race and Hispanic Origin: 

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101

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