The bar graph on the front cover depicts

the four leading causes of death in 2006:

HEART DISEASE, cancer, STROKE, and

COPD AND ALLIED CONDITIONS.


iii

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 

Foreword 

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.

Elizabeth G. Nabel, M.D. 

Director

National Heart, Lung, and Blood Institute

v

Contents

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.................................................................................................................................................... 5

Population ........................................................................................................................................................... 5

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

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

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

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

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

Cerebrovascular Diseases (Stroke).................................................................................................................... 19

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

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

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

4. Lung Diseases.................................................................................................................................................... 59

Chronic Obstructive Pulmonary Disease .......................................................................................................... 59

Asthma............................................................................................................................................................... 59

5. Blood Diseases................................................................................................................................................... 77

Appendixes.............................................................................................................................................................. 83

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

(6th, 7th, 8th, 9th, and 10th Revisions)......................................................................................................... 85

Appendix B. Estimated Comparability Ratios for Selected Causes of Death, U.S. ....................................... 87

Appendix C. Definition of Terms..................................................................................................................... 89

Appendix D. Abbreviations.............................................................................................................................. 91

Appendix E. References................................................................................................................................... 93

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 ............................................................................................................................................. 6

2–3 Average Remaining Lifetime Years by Age, Race, and Sex, U.S., 2006...................................................... 6

2–4 Age-Adjusted Death Rates for All Causes by Race and Sex, U.S., 1950–2006........................................... 7

2–5 Unadjusted Death Rates for Selected Causes, U.S., 1950–2006 .................................................................. 7

2–6 Number of Days of Inpatient Hospital Care by Major Diagnosis, U.S., 1990–2006 ................................... 8

2–7 Age-Adjusted Death Rates by Major Diagnosis, U.S., 1990–2006.............................................................. 8

2–8 Leading Causes of Death, U.S., 2006........................................................................................................... 9

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

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

2–11 Leading Causes of Death, White Females, U.S., 2006............................................................................... 10

2–12 Leading Causes of Death, Black Males, U.S., 2006....................................................................................11

2–13 Leading Causes of Death, Black Females, U.S., 2006 ................................................................................11

2–14 Leading Causes of Death, Asian Males, U.S., 2006 ................................................................................... 12

2–15 Leading Causes of Death, Asian Females, U.S., 2006................................................................................ 12

2–16 Leading Causes of Death, Hispanic Males, U.S., 2006.............................................................................. 13

2–17 Leading Causes of Death, Hispanic Females, U.S., 2006 .......................................................................... 13

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.............................................................. 14

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........................................................................................................................ 15

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............................................................................................. 16

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

U.S., 1976–1980 to 2003–2006 .................................................................................................................. 16

2–24 Projected Economic Cost of Cardiovascular, Lung, and Blood Diseases, U.S., 2010 ............................... 17

2–25 Projected Direct Cost of Cardiovascular, Lung, and Blood Diseases, U.S., 2010...................................... 17

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.................................................................................................................... 23

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 .................................................................................................................. 26

3–13 Age-Adjusted Death Rates for Heart Disease by Race/Ethnicity and Sex, U.S., 2006.............................. 27

3–14 Death Rates for Heart Disease in Males by Age and Race/Ethnicity, U.S., 2006 ...................................... 27

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 .................................................................................................................. 28

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............................................................................................................ 31

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

1950–2006 .................................................................................................................................................. 32

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

U.S., 1999–2006 ......................................................................................................................................... 32

3–25 Age-Adjusted Death Rates for Coronary Heart Disease by Race and Sex, U.S., 1950–2006.................... 33

3–26 Deaths and Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1980–2006............................. 33

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

by Race and Sex, U.S., 1950–2006............................................................................................................. 34

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

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

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

U.S., 2006 .................................................................................................................................................. 35
ix

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

U.S., 2006 ................................................................................................................................................... 35

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

U.S., 2006 ................................................................................................................................................... 36

3–32 Age-Adjusted Death Rates for Coronary Heart Disease by State, U.S., 2003–2005 ................................. 36

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

Ages 35–74, 2007 ....................................................................................................................................... 37

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

Ages 35–74, 1999–2007 ............................................................................................................................. 37

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

Ages 35–74, 1999–2007 ............................................................................................................................. 38

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

2003–2006 .................................................................................................................................................. 38

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

U.S., 1971–2006 ......................................................................................................................................... 39

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

65 and Older, U.S., 1982–2006................................................................................................................... 39

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

U.S., 1981–2006 ......................................................................................................................................... 40

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

1981–2006 .................................................................................................................................................. 40

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

Race/Ethnicity and Sex, U.S., 2006............................................................................................................ 41

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

Sex, U.S., 2006 ........................................................................................................................................... 41

3–43 Death Rates for Heart Failure as the Underlying Cause by Age, Race, and Sex, U.S., 2006..................... 42

3–44 Death Rates for Any Mention of Heart Failure by Age, Race, and Sex, U.S., 2006 .................................. 42

3–45 Age-Adjusted Death Rates for Cardiomyopathy by Race and Sex, U.S., 2006 ......................................... 43

3–46 Death Rates for Cardiomyopathy by Age, Race, and Sex, U.S., 2006 ....................................................... 43

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

1982–2006 .................................................................................................................................................. 44

3–48 Hospitalization Rates for Atrial Fibrillation by Age, U.S., 1982–2006...................................................... 44

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

2003–2006 .................................................................................................................................................. 45

3–50 Prevalence of Stroke by Age and Sex, U.S., 1999–2006............................................................................ 45

3–51 Prevalence of Stroke by Age and Race, U.S., 1999–2006.......................................................................... 46

3–52 Hospitalization Rates for Stroke, Ages 45–64 and 65 and Over, U.S., 1971–2006.................................... 46

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

U.S., 1971–2006 ......................................................................................................................................... 47
x

3–54 Age-Adjusted Death Rates for Stroke by Race and Sex, U.S., 1950–2006................................................ 47

3–55 Deaths and Age-Adjusted Death Rates for Stroke, U.S., 1979–2006......................................................... 48

3–56 Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 1999–2006................................ 48

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

and Sex, U.S., 1960–2006........................................................................................................................... 49

3–58 Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 2006.......................................... 49

3–59 Death Rates for Stroke in Males by Age and Race/Ethnicity, U.S., 2006 .................................................. 50

3–60 Death Rates for Stroke in Females by Age and Race/Ethnicity, U.S., 2006............................................... 50

3–61 Age-Adjusted Death Rates for Stroke by State, U.S., 2003–2005 ............................................................. 51

3–62 Age-Adjusted Death Rates for Stroke by Country and Sex, Ages 35–74, 2007......................................... 51

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

1999–2007 .................................................................................................................................................. 52

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

1999–2007 .................................................................................................................................................. 52

3–65 Prevalence of Hypertension and Prehypertension by Age, U.S., 1999–2006............................................. 53

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

U.S., 1999–2006 ......................................................................................................................................... 53

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

U.S., 1976–1980 to 2003–2006 .................................................................................................................. 54

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

to 2003–2006 .............................................................................................................................................. 54

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

to 2003–2006 .............................................................................................................................................. 55

3–70 Age-Adjusted Death Rates for Diseases of the Arteries by Race and Sex, U.S., 2006 .............................. 55

3–71 Death Rates for Diseases of the Arteries by Age, Race, and Sex, U.S., 2006 ............................................ 56

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

U.S., 1940–2006 ......................................................................................................................................... 56

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

U.S., 1970–2006 ......................................................................................................................................... 57

4. Lung Diseases

4–1 Deaths From Lung Diseases, Percent by Subgroup, U.S., 2006................................................................. 59

4–2 Number of Hospitalizations, Physician Office Visits, and Deaths for Lung Diseases, U.S., 2006 ............ 60

4–3 Age-Adjusted Death Rates for Total Lung Diseases by Race and Sex, U.S., 2006 ................................... 61

4–4 Death Rates for Total Lung Diseases by Age, Race, and Sex, U.S., 2006 ................................................. 61

4–5 Prevalence of Chronic Obstructive Pulmonary Disease by Age, U.S., 1997–2007 ................................... 62

4–6 Prevalence of Chronic Obstructive Pulmonary Disease by Age, Race, and Sex, U.S., 2007..................... 62

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

65 and Older, U.S., 1995–2006................................................................................................................... 63
xi

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

U.S., 1960–2006 ......................................................................................................................................... 63

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

and Sex, U.S., 1999–2006........................................................................................................................... 64

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

1960–2006 .................................................................................................................................................. 64

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

1960–2006 .................................................................................................................................................. 65

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

1960–2006 .................................................................................................................................................. 65

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

1960–2006 .................................................................................................................................................. 66

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

2003–2005 .................................................................................................................................................. 66

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

and Sex, Ages 35–74, 2007......................................................................................................................... 67

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

and Sex, U.S., 2006..................................................................................................................................... 67

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

U.S., 2006 ................................................................................................................................................... 68

4–18 Prevalence of Asthma Ages Younger Than 18 and 18 and Older, U.S., 1980–2007 .................................. 68

4–19 Prevalence of Asthma by Race, U.S., 1980–2007 ...................................................................................... 69

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

U.S., 2006 ................................................................................................................................................... 69

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

U.S., 2006 ................................................................................................................................................... 70

4–22 Physician Office Visits for Asthma, U.S., 1990–2006................................................................................ 70

4–23 Hospitalizations for Asthma by Primary and Secondary Diagnosis, U.S., 1980–2006.............................. 71

4–24 Hospitalizations for Asthma by Age, U.S., 1980–2006.............................................................................. 71

4–25 Age-Adjusted Death Rates for Asthma by Race and Sex, U.S., 2006........................................................ 72

4–26 Age-Adjusted Death Rates for Asthma by Race and Sex, Ages 1–24, U.S., 1980–2006........................... 72

4–27 Age-Adjusted Death Rates for Asthma by Race and Sex, U.S., 1980–2006.............................................. 73

4–28 Death Rates for Asthma by Age, Race, and Sex, U.S., 1999–2006............................................................ 73

4–29 Age-Adjusted Death Rates for Asthma by Country and Sex, 2007............................................................ 74

4–30 Infant Mortality Rate for Respiratory Distress Syndrome, U.S., 1968–2006............................................. 74

4–31 Infant Mortality Rate for Respiratory Distress Syndrome by Race, U.S., 1980–2006............................... 75

4–32 Infant Mortality Rate for Respiratory Distress Syndrome by Race/Ethnicity, U.S., 2005 ......................... 75

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

U.S., 2005 ................................................................................................................................................... 76
xii

5. Blood Diseases

5–1 Blood Disease Deaths, Percent by Subgroup, U.S., 2006 .......................................................................... 77

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

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

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

1982–2006 .................................................................................................................................................. 79

5–4 Age-Adjusted Death Rates for Aplastic Anemia by Race and Sex, U.S., 2003–2006 ............................... 79

5–5 Death Rates for Aplastic Anemia by Age, Race, and Sex, U.S., 2003–2006 ............................................. 80

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

and 15–44, U.S., 1982–2006....................................................................................................................... 80

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

1980–1984 to 2003–2006 .......................................................................................................................... 81

5–8 Death Rates for Sickle Cell Anemia in Blacks by Age and Sex, U.S., 2003–2006.................................... 81
1

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.

1. Introduction
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. 

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 event-based rather than patient-based, 

annual estimates pertain to numbers of hospitalizations, not to numbers of patients hospitalized in a 

given year. 

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.

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.

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
3

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. Ageadjusted 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 age-adjusted 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.

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.
4

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

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.

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.

2. Background Data
6

Background Data

Chart 2–1 

Total Population by Mean Age, Percent Age 65 and Older, 

Race/Ethnicity, and Sex, U.S., 2007

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.

Chart 2–2

Total Projected Population by Mean Age, Percent Age 65 and Older, 

Race/Ethnicity, and Sex, U.S., 2020

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

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

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

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

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
7

Background Data

Black* Male White Male Black* Female White Female

2,500

2,000

1,500

1,000

500

0

* Nonwhite from 1950 to 1967.

Deaths/100,000 Population

Chart 2–4 

Age-Adjusted Death Rates for All Causes 

by Race and Sex, U.S., 1950–2006

Chart 2–5 

Unadjusted Death Rates for Selected Causes, 

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

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

Year

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

400

300

200

100

0

Deaths/100,000 Population

ICD-6 ICD-7 ICD-8 ICD-9 ICD-10

CHD Stroke Lung Cancer Other Cancer COPD

Year

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

ICD-6 ICD-7 ICD-8 ICD-9 ICD-10

Black* Male White Male Black* Female White Female

CHD Stroke Lung Cancer Other Cancer COPD
8

Cardiovascular Respiratory Mental

Digestive Injury and Poisoning Neoplasms

Musculoskeletal Endocrine

Background Data

Chart 2–6 

Number of Days of Inpatient Hospital Care 

by Major Diagnosis, U.S., 1990–2006

45

40

35

30

25

20

15

10

5

0

Days of Care (Millions)

Chart 2–7 

Age-Adjusted Death Rates 

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

450

400

350

300

250

200

150

100

50

0

Cardiovascular Neoplasms Respiratory

Injury and Poisoning Endocrine Digestive

Mental Musculoskeletal

Deaths/100,000 Population

From 1990 to 2006, ageadjusted death rates for 

cardiovascular and respiratory 

diseases ranked first and third, 

respectively.15, 35

Year

1990 1995 2000 2005

1990 1995 2000 2005

Year

Cardiovascular Respiratory Mental

Digestive Injury and Poisoning Neoplasms

Musculoskeletal Endocrine

ICD-9 ICD-10

Cardiovascular Neoplasms Respiratory

Injury and Poisoning Endocrine Digestive

Mental Musculoskeletal
9

Background Data

Chart 2–8 

Leading Causes of Death, 

U.S., 2006

Chart 2–9 

Leading Causes of Death 

by Age and Rank, 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

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 Number

Total Deaths 2,426,264

Heart disease* 631,636

Cancer 559,888

Cerebrovascular diseases (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.

Cause of Death 1–24 25–44 45–64 ≥65

Heart disease 5 3 2 1

Cancer 4 2 1 2

Cerebrovascular diseases (stroke) 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.
10

Background Data

Chart 2–10 

Leading Causes of Death, 

White Males, U.S., 2006

35

30

25

20

15

10

5

0

Heart Cancer Accidents COPD and Stroke Diabetes

Disease Allied

Conditions*

* Chronic lower respiratory diseases.

Percent of All Deaths

Chart 2–11 

Leading Causes of Death, 

White Females, 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

Heart Cancer Stroke COPD and Alzheimer’s Accidents

Disease Allied Disease

Conditions*

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

Percent of All Deaths

35

30

25

20

15

10

5

0

* Chronic lower respiratory diseases.
11

Background Data

Chart 2–12 

Leading Causes of Death, 

Black Males, U.S., 2006

Chart 2–13 

Leading Causes of Death, 

Black Females, U.S., 2006

In 2006, among black males, 

heart disease and stroke were 

the first and fifth leading causes 

of death, respectively.36

In 2006, among black females, 

heart disease and stroke were 

the first and third leading causes 

of death, respectively.36

35

30

25

20

15

10

5

0

Heart Cancer Accidents Homicide Stroke Diabetes

Disease

Percent of All Deaths

35

30

25

20

15

10

5

0

Heart Cancer Stroke Diabetes Nephritis Accidents

Disease

Percent of All Deaths
12

Background Data

* Chronic lower respiratory diseases.

Chart 2–14 

Leading Causes of Death, 

Asian Males, U.S., 2006

Chart 2–15 

Leading Causes of Death, 

Asian Females, 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

In 2006, among Asian females, 

heart disease and stroke were the 

second and third leading causes 

of death, respectively.36

35

30

25

20

15

10

5

0

Cancer Heart Stroke Accidents COPD and Diabetes

Disease Allied

Conditions*

Percent of All Deaths

35

30

25

20

15

10

5

0

Cancer Heart Stroke Accidents Diabetes Influenza/

Disease Pneumonia

Percent of All Deaths
13

Background Data

Chart 2–16 

Leading Causes of Death, 

Hispanic Males, U.S., 2006

Chart 2–17 

Leading Causes of Death, 

Hispanic Females, U.S., 2006

In 2006, among Hispanic males, 

heart disease and stroke were the 

first and fourth leading causes of 

death, respectively.36

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

35

30

25

20

15

10

5

0

Heart Cancer Accidents Stroke Diabetes Homicide

Disease

Percent of All Deaths

35

30

25

20

15

10

5

0

Heart Cancer Stroke Diabetes Accidents COPD and

Disease Allied

Conditions*

Percent of All Deaths

* Chronic lower respiratory diseases.
14

Background Data

Chart 2–18 

Leading Causes of Death, 

American Indian Males, U.S., 2006

Chart 2–19 

Leading Causes of Death, 

American Indian Females, U.S., 2006

In 2006, among American 

Indian males, heart disease was 

the leading cause of death.36

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

35

30

25

20

15

10

5

0

Heart Cancer Accidents Diabetes Chronic Suicide

Disease Liver

Disease

Percent of All Deaths

35

30

25

20

15

10

5

0

Cancer Heart Accidents Diabetes Stroke COPD and

Disease Allied

Conditions*

Percent of All Deaths

* Chronic lower respiratory diseases.
15

Black Male White Male Black Female White Female

Background Data

Chart 2–20 

Prevalence of Leading Chronic Conditions 

Causing Limitation of Activity, U.S., 2007

Chart 2–21 

Age-Adjusted Percent of Population Currently Smoking 

by Race and Sex, Ages 18 and Older, U.S., 1965–2007

70

60

50

40

30

20

10

0

Percent

In 2007, heart disease was the 

third leading chronic condition 

causing activity limitation. 

Hypertension, lung condition, 

and stroke were also very 

common.24

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

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

1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

Black Male White Male Black Female White Female
16

Background Data

1976–1980 1988–1994 1999–2002 2003–2006

35

30

25

20

15

10

5

0

White† White† Black† Black† Mexican- MexicanMale Female Male Female American American

Male Female

* High serum cholesterol is ≥240 mg/dL.

†

 Non-Hispanic.

Percent

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

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 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 MexicanAmerican females.17, 37

From 1976–1980 to 2003–2006, 

the prevalence of overweight 

males and females increased for 

each racial/ethnic group.17, 37

1976–1980 1988–1994 1999–2002 2003–2006

100

80

60

40

20

0

White† White† Black† Black† Mexican- MexicanMale Female Male Female American American

Male Female

Percent

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

. † Non-Hispanic.

1976–1980 1988–1994 1999–2002 2003–2006

1976–1980 1988–1994 1999–2002 2003–2006
17

Background Data

Chart 2–24 

Projected Economic Cost of Cardiovascular,

Lung, and Blood Diseases, U.S., 2010

Chart 2–25 

Projected Direct 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

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 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.

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.

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 
20

coded to ill-defined 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

Other CHD

44.8%

AMI

22.3%

Heart Failure 

(Underlying)*

9.5%

Other

7.2%

Rhythmic

Hypertensive 6.1%

5.2%

Cardiomyopathy

4.0%

Rheumatic/

Congenital

1.0%

CHD

51.2%

Stroke

16.5%

Other CVD

14.5%

Heart Failure (Underlying)*

7.3%

Hypertensive Diseases

6.8% Diseases of Arteries

3.7%

Cardiovascular Diseases

Chart 3–1 

Cardiovascular Disease Deaths, 

Percent by Subgroup, U.S., 2006

* 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.

Stroke

16.5%

Diseases of 

Arteries

3.7%

Heart Failure

(Underlying)*

7.3%

Other CVD

14.5% CHD

51.2%

Hypertensive

Diseases

6.8%

Chart 3–2 

Heart Disease Deaths, 

Percent by Subgroup, U.S., 2006

* 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

Stroke Unspecified

Other Hemorrhage

19.8%

Stroke, Unspecified

52.9%

Other Cerebrovascular

17.9%

Cerebral Infarction

Subarachnoid Hemorrhage5.1%

4.3%

Total deaths = 137,119 (100%).

Cerebral

Infarction

5.1%

Other 

Cerebrovascular

17.9%

Subarachnoid

Hemorrhage

4.3%

Stroke, 

Unspecified

52.9%

Other 

Hemorrhage

19.8%

Rhythmic

6.1%

Other

7.2%

AMI

22.3%

Other CHD

44.8%

Cardiomyopathy

4.0%

Hypertensive 

5.2%

Heart Failure

(Underlying)*

9.5%

Rheumatic/

Congenital

1.0%
22

Cardiovascular Diseases

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 disease 747 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

Cardiovascular Diseases

Chart 3–6 

Age-Adjusted Death Rates and Percent Change for All Causes 

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

Deaths/100,000 Pop. 1968–2006

Cause of Death 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.

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

From 1968 to 2006, the death 

rate for CVD declined 65%, 

compared with a 5.7% decline 

in the rate for all non-CVD 

causes. Mortality for CHD and 

stroke declined 72% and 73%, 

respectively.31, 32

Chart 3–5 

Change in Age-Adjusted Death Rates, 

U.S., 1950–2006

CHD Stroke Non-CVD

ICD-6 ICD-8 ICD-9 ICD-10

20

10

0

-10

-20

-30

-40

-50

-60

-70

-80

Percent Change

Year

CHD Stroke* Non-CVD

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

ICD-6 ICD-7 ICD-8 ICD-9 ICD-10

* The comparability ratio 1.0502 was applied to the death rates reported in vital statistics for 

1979–1998.
24

Chart 3–7 

Average Annual Percent Change in Age-Adjusted Death Rates 

for All Causes and Cardiovascular Diseases, U.S., 1968–2006

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.

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

Cardiovascular Diseases

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

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

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

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

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

Cardiovascular Diseases

Chart 3–10 

Percent of All Deaths Due to Cardiovascular 

Diseases* by Age, U.S., 2006

Chart 3–9 

Deaths and Age-Adjusted Death Rates for 

Cardiovascular Diseases, U.S., 1979–2006

Percent of All Deaths

50

40

30

20

10

0

Age (Years)

Percent of All Deaths

<1 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 ≥85

1,200

1,000

800

600

400

200

0

Year

Deaths in Thousands (Bar) Deaths/100,000 Population (Line)

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

600

500

400

300

200

100

0

* Includes congenital malformations of the circulatory system.
26

Cardiovascular Diseases

In 2003–2005, CVD mortality was generally highest in the 

Southeastern United States.15

From 1993–1995 to 2003–2005, 

the smallest percent declines in 

death rates for CVD tended to 

be in the Southeastern United 

States.15

Chart 3–12 

Percent Decline in Age-Adjusted Death Rates for 

Cardiovascular Diseases* by State, U.S., 1993–1995 to 2003–2005

Chart 3–11 

Age-Adjusted Death Rates for Cardiovascular Diseases* 

by State, U.S., 2003–2005

* Excludes congenital malformations of the circulatory system.

* Excludes congenital malformations of the circulatory system.

Deaths/100,000 Population

321–380 (9)

300–320 (9)

261–299 (11)

251–260 (11)

214–250 (10)

Percent Decline

27.1–33.0 (11)

25.0–27.0 (9)

23.5–24.9 (9)

21.8–23.4 (10)

14.3–21.7 (11)
27

Total Heart Disease

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 

In 2006, heart disease mortality 

in males was highest in nonHispanic blacks across all age 

groups. This disparity was 

proportionately greater in 

younger age groups than in 

older age groups.36

Chart 3–13 

Age-Adjusted Death Rates for Heart Disease 

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

Chart 3–14 

Death Rates for Heart Disease in Males 

by Age and Race/Ethnicity, U.S., 2006

1 2

Total Black* White* Am Indian Hispanic Asian

350

300

250

200

150

100

50

0

Deaths/100,000 Population

* Non-Hispanic.

Total Black* White* American Hispanic Asian

Indian

Male Female

Black* White* Am Indian Hispanic Asian

2,500

2,000

1,500

1,000

500

0

Black* White* Hispanic American Asian

Indian

Deaths/100,000 Population

45–54 55–64 65–74 75–84

Age (Years)

* Non-Hispanic.
28

Total Heart Disease/Coronary Heart Disease

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

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

Chart 3–16 

Age-Adjusted Prevalence of Acute Myocardial Infarction by 

Race and Sex, Ages 25–74, U.S., 1971–1975 to 2003–2006

Chart 3–15 

Death Rates for Heart Disease in Females 

by Age and Race/Ethnicity, U.S., 2006

Black* White* Am Indian Hispanic Asian

2,500

2,000

1,500

1,000

500

0

Black* White* American Hispanic Asian

Indian

Deaths/100,000 Population

45–54 55–64 65–74 75–84

Age (Years)

1971–1975 1976–1980 1988–1994 1999–2002 2003–2006

6

4

2

0

Percent of Population

Black White Male Female

1971–1975 1976–1980 1988–1994 1999–2002 2003–2006

* Non-Hispanic.
29

Coronary Heart Disease

Chart 3–17 

Prevalence of Acute Myocardial Infarction 

by Age and Sex, U.S., 1999–2006

Percent of Population

In 1999–2006, the prevalence 

of AMI was higher in males 

than in females and increased 

substantially with age.17

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

Chart 3–18 

Prevalence of Acute Myocardial Infarction 

by Age and Race, U.S., 1999–2006

Male Female

20

15

10

5

0

Male Female

35–44 45–54 55–64 65–74 ≥75

Age (Years)

Black White

20

15

10

5

0

Percent of Population

35–44 45–54 55–64 65–74 ≥75

Age (Years)

Black White
30

Coronary Heart Disease

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

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

Chart 3–20 

Prevalence of Angina Pectoris by Age and Race, 

U.S., 1999–2006

Chart 3–19 

Prevalence of Angina Pectoris by Age and Sex, 

U.S., 1999–2006

Male Female

20

15

10

5

0

 Male Female

Percent of Population

35–44 45–54 55–64 65–74 ≥75

Age (Years)

Black White

20

15

10

5

0

 Black White

Percent of Population

35–44 45–54 55–64 65–74 ≥75

Age (Years)
31

Coronary Heart Disease

For those aged 45–64 years, 

hospitalization rates for AMI 

increased from 1965 to the mid1970s and then remained stable 

before declining in the mid1990s. 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

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

Chart 3–21 

Hospitalization Rates for Acute Myocardial Infarction, 

Ages 45–64 and 65 and Older, U.S., 1965–2006

Ages 45–64 Years Ages ≥65 Years

200

150

100

50

0

 Ages 45–64 Years Ages ≥65 Years

Hospitalizations/10,000 Population

1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

Chart 3–22 

Hospital Case-Fatality Rates for Acute Myocardial Infarction, 

Ages Younger Than 65 and 65 and Older, U.S., 1970–2006

Ages <65 Years Ages ≥65 Years

40

30

20

10

0

 Ages <65 Years Ages ≥65 Years

Percent Discharged Dead

1970 1975 1980 1985 1990 1995 2000 2005

Year
32

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Actual Rate Rate if Rise Continued Peak Rate

Peak minus actual rates 

results in 1,086,000 fewer 

deaths in 2006 than 

expected: 

Actual: 425,000

Expected: 1,511,000

Coronary Heart Disease

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

Chart 3–23 

Age-Adjusted Death Rates for Coronary Heart Disease, 

Actual and Expected, U.S., 1950–2006

700

600

500

400

300

200

100

0

 Actual Rate Rate if Rise Continued Peak Rate

Deaths/100,000 Population

Year

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Peak minus actual 

rates results in 

1,086,000 fewer deaths 

in 2006 than expected:

Actual: 425,000

Expected: 1,511,000

Chart 3–24 

Age-Adjusted Death Rates for Coronary Heart Disease 

by Race/Ethnicity and Sex, U.S., 1999–2006

Male Female

Black* White* American Indian Hispanic Asian

Black* White* American Indian Hispanic Asian

Male

300

250

200

150

100

50

0

Deaths/100,000 Population

Year

Black* White* American Hispanic Asian 

Indian

1999 2001 2003 2005 1999 2001 2003 2005

* Non-Hispanic.

From 1999 to 2006, CHD mortality declined in non-Hispanic 

whites, non-Hispanic blacks, 

Hispanics, Asians, and American Indians, both male and 

female.36

Female
33

700

600

500

400

300

200

100

0

ICD-6 ICD-7 ICD-8 ICD-9 ICD-10

Black* Male White Male Black* Female White Female

Coronary Heart Disease

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

Chart 3–25 

Age-Adjusted Death Rates for Coronary Heart Disease 

by Race and Sex, U.S., 1950–2006

Deaths in Thousands (Bar) Deaths/100,000 Population (Line)

Year

700

600

500

400

300

200

100

0

350

300

250

200

150

100

50

0

* Nonwhite from 1950 to 1967.

 Black* Male White Male Black* Female White Female

Deaths/100,000 Population

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

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

	 ICD-6	 ICD-7	 ICD-8	 ICD-9	 ICD-10

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
34

-7.0 -6.0 -5.0 -4.0 -3.0 -2.0 -1.0 0.0 1.0 2.0

Chart 3–27 

Average Annual Percent Change in Age-Adjusted Death Rates for 

Coronary Heart Disease by Race and Sex, U.S., 1950–2006

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.

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

35–44

45–54

55–64

65–74

75–84

≥85

35–44

45–54

55–64

65–74

75–84

≥85

35–44

45–54

55–64

65–74

75–84

≥85

35–44

45–54

55–64

65–74

75–84

≥85

-7 -6 -5 -4 -3 -2 -1 0 1 2

Average Annual Percent Change

Black Male

White Male

Black Female

White Female

Age (Years)

Coronary Heart Disease

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
35

Black* White* Am Indian Hispanic Asian

Male Female

Total Black* White* Am Indian Hispanic Asian

Coronary Heart Disease

Chart 3–29 

Age-Adjusted Death Rates for Coronary Heart Disease 

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

Total Black* White* American Hispanic Asian

Indian

Male Female

250

200

150

100

50

0

Deaths/100,000 Population

* Non-Hispanic.

In 2006, CHD mortality was 

70% higher in males than in 

females. Within sex groups, 

it was highest in non-Hispanic 

blacks and lowest in Asians.36

1,600

1,200

800

400

0

Deaths/100,000 Population

45–54 55–64 65–74 75–84

Age (Years)

In 2006, CHD mortality in 

males increased with age from 

45–54 to 75–84 years for nonHispanic blacks, non-Hispanic 

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

Chart 3–30 

Death Rates for Coronary Heart Disease in Males 

by Age and Race/Ethnicity, U.S., 2006

* Non-Hispanic.

Black* White* American Hispanic Asian

Indian
36

Coronary Heart Disease

Black* White* Am Indian Hispanic Asian

1,600

1,200

800

400

0

Deaths/100,000 Population

45–54 55–64 65–74 75–84

Age (Years)

Chart 3–31 

Death Rates for Coronary Heart Disease in Females 

by Age and Race/Ethnicity, U.S., 2006

* Non-Hispanic.

In 2006, CHD mortality in 

females increased with age from 

45–54 to 75–84 years for nonHispanic blacks, non-Hispanic 

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

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

Deaths/100,000 Population

166–205 (11)

151–165 (10)

131–151 (10)

123–130 (9)

 90–122 (10)

Black* White* American Hispanic Asian

Indian
37

Female

-200.0 -100.0 0.0 100.0 200.0 300.0 400.0

Male

Coronary Heart Disease

ROM 

CZR 

POL†

SCO 

FIN 

USA†

EW 

GER†

SWE†

NOR†

DEN†

ITA†

NTH

FRA†

KOR†

JPN

200 100 0 100 200 300 400

Female Male

Deaths/100,000 Population

* Age adjusted to European standard.

†

 Data for 2006.

-10.0 -8.0 -6.0 -4.0 -2.0 0.0

Average Annual Percent Change†

-10 -8 -6 -4 -2 0

Average Annual Percent Change‡

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.

Chart 3–33 

Age-Adjusted Death Rates* for Coronary Heart Disease 

by Country and Sex, Ages 35–74, 2007

Chart 3–34 

Change in Age-Adjusted Death Rates* for Coronary Heart Disease 

in Males by Country, Ages 35–74, 1999–2007†

In 2006–2007, among 16 industrialized countries, the United 

States ranked sixth highest for 

CHD mortality in males and 

fourth highest in females.45

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

DEN (99–06)

NTH (99–07)

NOR (99–06)

EW (01–07)

GER (99–06)

POL (99–06)

FIN (99–07)

FRA (00–06)

USA (99–06)

CZR (99–07)

ROM (99–07)

JPN (99–07)

KOR (99–06)
38

1971–1975 1976–1980 1988–1994 1999–2002 2003–2006

4

3

2

1

0

Percent of Population

-10.0 -8.0 -6.0 -4.0 -2.0 0.0

Average Annual Percent Change†

NOR (99–06)

DEN (99–06)

NTH (99–07)

EW (01–07)

GER (99–06)

FIN (99–07)

POL (99–06)

FRA (00–06)

CZR (99–07)

USA (99–06)

ROM (99–07)

JPN (99–07)

KOR (99–06)

-10 -8 -6 -4 -2 0

Average Annual Percent Change‡

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.

Black White Male Female

Coronary Heart Disease/Heart Failure

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

Chart 3–35 

Change in Age–Adjusted Death Rates* for Coronary Heart Disease 

in Females by Country, Ages 35–74, 1999–2007†

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

Chart 3–36 

Age-Adjusted Prevalence of Heart Failure by Race and Sex, 

Ages 25–74, U.S., 1971–1975 to 2003–2006

1971–1975 1976–1980 1988–1994 1999–2002 2003–2006
39

1979 1984 1989 1994 1999 2004

Age <65 Years Age ≥65 Years

Congestive Heart Failure

1970 1975 1980 1985 1990 1995 2000 2005

Ages 45–64 Years Ages ≥65 Years

250

200

150

100

50

0

 Ages <65 Years Ages ≥65 Years

Hospitalizations/10,000 Population

1970 1975 1980 1985 1990 1995 2000 2005

Year

14

12

10

8

6

4

2

0

 Ages <65 Years Ages ≥65 Years

Percent Discharged Dead

Year

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

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

Chart 3–37 

Hospitalization Rates for Congestive Heart Failure, 

Ages Younger Than 65 and 65 and Older, U.S., 1971–2006

Chart 3–38 

Hospital Case-Fatality Rates for Congestive Heart Failure, 

Ages Younger Than 65 and 65 and Older, U.S., 1982–2006

1980 1985 1990 1995 2000 2005
40

ICD-9 ICD-10

1979 1984 1989 1994 1999 2004

Year

Black Male White Male Black Female White Female

ICD-9 ICD-10

1979 1984 1989 1994 1999 2004

Year

Black Male White Male Black Female White Female

40

30

20

10

0

Black Male White Male Black Female White Female

Deaths/100,000 Population

1980 1985 1990 1995 2000 2005

200

150

100

50

0

Deaths/100,000 Population

ICD-9 ICD-10

Heart Failure

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

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

Chart 3–40 

Age-Adjusted Death Rates for Any Mention of Heart Failure 

by Race and Sex, U.S., 1981–2006

Chart 3–39 

Age-Adjusted Death Rates for Heart Failure as the 

Underlying Cause by Race and Sex, U.S., 1981–2006

Year

Black Male White Male Black Female White Female

Year

1980 1985 1990 1995 2000 2005

ICD-9 ICD-10
41

Heart Failure

Male Female

Total Black* White* Am Indian Hispanic Asian

25

20

15

10

5

0

Total Black* White* American Hispanic Asian

Indian

Deaths/100,000 Population

Male Female

Chart 3–42 

Age-Adjusted Death Rates for Any Mention of Heart Failure 

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

Male Female

Total Black* White* Am Indian Hispanic Asian

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 

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 nonHispanic whites and lowest in 

Asians.36 

Chart 3–41 

Age-Adjusted Death Rates for Heart Failure as the Underlying Cause 

of Death by Race/Ethnicity and Sex, U.S., 2006

* Non-Hispanic.

Deaths/100,000 Population

* Non-Hispanic.

120

100

80

60

40

20

0

Male Female

Total Black* White* American Hispanic Asian

Indian
42

Heart Failure

25–44 45–54 55–64 65–74 75–84

Age	(Years)

Black Male White Male Black Female White Female

25-44 45-54 55-64 65-74 75-84

Age (Years)

Black Male White Male Black Female White Female

200

150

100

50

0

Deaths/100,000 Population

25–44 45–54 55–64 65–74 75–84

Age (Years)

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 

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

Chart 3–43 

Death Rates for Heart Failure as the Underlying Cause 

by Age, Race, and Sex, U.S., 2006

Chart 3–44 

Death Rates for Any Mention of Heart Failure 

by Age, Race, and Sex, U.S., 2006

Black Male White Male Black Female White Female

Deaths/100,000 Population

Age (Years)

25–44 45–54 55–64 65–74 75–84

1,000

800

600

400

200

0

Black Male White Male Black Female White Female
43

Cardiomyopathy

35–44 45–54 55–64 65–74 75–84

Age	(Years)

Black Male White Male Black Female White Female

120

100

80

60

40

20

0

Black Male White Male Black Female White Female

Deaths/100,000 Population

35–44 45–54 55–64 65–74 75–84

Age (Years)

Male Female

Total White Black

25

20

15

10

5

0

Total White Black

Deaths/100,000 Population

Male Female

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

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

Chart 3–45 

Age-Adjusted Death Rates for Cardiomyopathy 

by Race and Sex, U.S., 2006

Chart 3–46 

Death Rates for Cardiomyopathy 

by Age, Race, and Sex, U.S., 2006
44

1982 1987 1992 1997 2002 Year

Primary Diagnosis Primary Diagnosis Secondary Diagnosis Secondary Diagnosis

Hospitalizations (Thousands)

1982 1987 1992 1997 2002

Year

1982 1987 1992 1997 2002 Year

Ages 45–64 Years Ages ≥65 Years

100

80

60

40

20

0

 Ages 45–64 Years Ages ≥65 Years

Hospitalizations/10,000 Population

Year

3,000

2,500

2,000

1,500

1,000

500

0

1982 1987 1992 1997 2002

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

Chart 3–48 

Hospitalization Rates for Atrial Fibrillation 

by Age, U.S., 1982–2006

Chart 3–47 

Hospitalizations for Atrial Fibrillation by Primary 

and Secondary Diagnosis, 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

Atrial Fibrillation
45

Black White Male Female

1971–1975 1976–1980 1988–1994 1999–2002 2003–2006

4

3

2

1

0

Percent of Population

1971–1975 1976–1980 1988–1994 1999–2002 2003–2006

35–44 45–54 55–64 65–74 ≥75

Age

Male Female

16

12

8

4

0

 Male Female

Percent of Population

35–44 45–54 55–64 65–74 ≥75

Age (Years)

Black White Male Female

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

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

Chart 3–49 

Age-Adjusted Prevalence of Stroke by Race and Sex, 

Ages 25–74, U.S., 1971–1975 to 2003–2006

Chart 3–50 

Prevalence of Stroke by Age and Sex, 

U.S., 1999–2006

Cerebrovascular Diseases (Stroke)
46

35–44 45–54 55–64 65–74 ≥75

Age (Years)

Black White

16

12

8

4

0

 Black White

Percent of Population

35–44 45–54 55–64 65–74 ≥75

Age (Years)

1971 1976 1981 1986 1991 1996 2001 2006

Year

Ages 45–64 Years Ages ≥65 Years

300

250

200

150

100

50

0

 Ages 45–64 Years Ages ≥65 Years

Hospitalizations/10,000 Population

1971 1976 1981 1986 1991 1996 2001 2006

Year

Cerebrovascular Diseases (Stroke)

In 1999–2006, the prevalence 

of stroke increased with age 

and was higher in blacks than in 

whites at all ages.17

Hospitalization rates for stroke 

in those aged 45–64 years 

increased from 1971 to the mid1980s, 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

Chart 3–52 

Hospitalization Rates for Stroke, 

Ages 45–64 and 65 and Over, U.S., 1971–2006

Chart 3–51 

Prevalence of Stroke by Age and Race, 

U.S., 1999–2006
47

1971 1976 1981 1986 1991 1996 2001 2006

Year

Ages 45–64 Years Ages ≥65 Years

25

20

15

10

5

0

 Ages <65 Years Ages ≥65 Years

Percent Discharged Dead

1971 1976 1981 1986 1991 1996 2001 2006

Year

* Nonwhite from 1950 to 1967.

ICD-6 ICD-7 ICD-8 ICD-9 ICD-10

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

Black* Male White Male Black* Female White Female

250

200

150

100

50

0

 Black* Male White Male Black* Female White Female

Deaths/100,000 Population

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

ICD-6 ICD-7 ICD-8 ICD-9 ICD-10

* Estimates are not available for 1976 and 1977.

Cerebrovascular Diseases (Stroke)

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

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

Chart 3–53 

Hospital Case-Fatality Rate for Stroke, 

Ages Younger Than 65 and 65 and Over, U.S., 1971–2006*

Chart 3–54 

Age-Adjusted Death Rates for Stroke 

by Race and Sex, U.S., 1950–2006
48

Cerebrovascular Diseases (Stroke)

Year

200

150

100

50

0

Deaths in Thousands (Bar) Deaths/100,000 Population (Line)

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Year

125

100

75

50

25

0

Male Female

1999 2000 2001 2002 2003 2004 2005 2006 1999 2000 2001 2002 2003 2004 2005 2006

Year

Black* White* Am Indian Hispanic Asian

100

80

60

40

20

0

Year

Black* White* American Hispanic Asian 

Indian

Deaths/100,000 Population

1999 2000 2001 2002 2003 2004 2005 2006 1999 2000 2001 2002 2003 2004 2005 2006

Male

* The comparability ratio 1.0502 was applied to the deaths and rates reported in vital statistics for 

1979–1998.

* Non-Hispanic.

Female

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 age-adjusted death 

rates were stable for most of the 

1990s but began to decline in 

1998 through 2006.31, 32

From 1999 to 2006, stroke 

mortality declined for nonHispanic blacks, non-Hispanic 

whites, Asians, Hispanics, and 

American Indians, both male 

and female.36 

Chart 3–56 

Age-Adjusted Death Rates for Stroke 

by Race/Ethnicity and Sex, U.S., 1999–2006

Chart 3–55 

Deaths and Age-Adjusted Death Rates for Stroke, 

U.S., 1979–2006*
49

Cerebrovascular Diseases (Stroke)

Male Female

Total Black* White* Am Indian Hispanic Asian

80

60

40

20

0

Total Black* White* American Hispanic Asian

Indian

Deaths/100,000 Population

Male Female

Chart 3–57 

Average Annual Percent Change in Age-Adjusted Death Rates for 

Stroke by Race and Sex, U.S., 1960–2006

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.

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

In 2006, stroke mortality was 

about the same in males and 

females. By race/ethnicity, 

death rates were highest in nonHispanic blacks and lowest in 

American Indians.36

Chart 3–58 

Age-Adjusted Death Rates for Stroke 

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

* Non-Hispanic.
50

Cerebrovascular Diseases (Stroke)

45-54 55-64 65-74 75-84

Black* White* Am Indian Hispanic Asian

600

500

400

300

200

100

0

Black* White* American Hispanic Asian

Indian

Deaths/100,000 Population

45–54 55–64 65–74 75–84

Age (Years)

45–54 55–64 65–74 75–84

Black* White* Am Indian Hispanic Asian

Age (Years)

In 2006, stroke mortality in 

males increased with age from 

45–54 to 75–84 years for nonHispanic blacks, non-Hispanic 

whites, Hispanics, American 

Indians, and Asians.36

In 2006, stroke mortality in 

females increased with age from 

45–54 to 75–84 years for nonHispanic blacks, non-Hispanic 

whites, Hispanics, American 

Indians, and Asians.36

Chart 3–60 

Death Rates for Stroke in Females 

by Age and Race/Ethnicity, U.S., 2006

Chart 3–59 

Death Rates for Stroke in Males 

by Age and Race/Ethnicity, U.S., 2006

* Non-Hispanic.

* Non-Hispanic.

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

600

500

400

300

200

100

0

Black* White* American Hispanic Asian

Indian†

45–54 55–64 65–74 75–84

Age (Years)

Deaths/100,000 Population
51

Cerebrovascular Diseases (Stroke)

Female

-200.0 -150.0 -100.0 -50.0 0.0 50.0 100.0 150.0 200.0 250.0

Deaths/100,000 Population

Male

ROM 

POL

KOR†

CZR

JPN

FIN

SCO

DEN†

GER†

EW

USA†

ITA†

NTH

NOR†

FRA†

SWE†

200 150 100 50 0 50 100 150 200 250

Female Male

Deaths/100,000 Population

* Age adjusted to European standard.

†

 Data for 2006.

In 2003–2005, stroke mortality was highest in many of the 

Southeastern states, most of 

which comprise “the stroke 

belt.”15

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

Chart 3–61 

Age-Adjusted Death Rates for Stroke 

by State, U.S., 2003–2005

Chart 3–62 

Age-Adjusted Death Rates* for Stroke by 

Country and Sex, Ages 35–74, 2007

Deaths/100,000 Population

58.0–64.0 (10)

54.0–57.9 (9)

50.0–53.9 (10)

45.0–49.9 (10)

30.0–44.9 (11)
52

-10 -8 -6 -4 -2 0

Average Annual Percent Change‡ Average Annual Percent Change‡

-8 -6 -4 -2 0

Average Annual Percent Change‡

-8 -6 -4 -2 0

Average Annual Percent Change‡

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.

Cerebrovascular Diseases (Stroke)

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

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

Chart 3–64 

Change in Age-Adjusted Death Rates* for Stroke 

in Females by Country, Ages 35–74, 1999–2007†

Chart 3–63 

Change in Age-Adjusted Death Rates* for Stroke 

in Males by Country, Ages 35–74, 1999–2007†

KOR (99–06)

EW (01–07)

NOR (99–06)

CZR (99–07)

NTH (99–07)

GER (99–06)

FRA (00–06)

FIN (99–07)

DEN (99–06)

POL (99–06)

JPN (99–07)

USA (99–06)

ROM (99–07)

* Age adjusted to European standard.

†

 Data for years indicated in parentheses.

‡

 Based on a log linear regression of the actual rates.

KOR (99–06)

CZR (99–06)

EW (01–07)

GER (99–06)

NTH (99–07)

FIN (99–07)

JPN (99–07)

NOR (99–06)

FRA (00–06)

USA (99–06)

ROM (99–07)

DEN (99–06)

POL (99–06)

-10 -8 -6 -4 -2 0
53

In 1999–2006, the prevalence of 

hypertension was appreciably 

higher in non-Hispanic blacks 

than in non-Hispanic whites 

or Mexican-Americans aged 

20–74 years. Within racial 

groups, the prevalence of hypertension was similar in males and 

females.17

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 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

Chart 3–65 

Prevalence of Hypertension* and Prehypertension†

by Age, U.S., 1999–2006

Hypertension

18–29 30–39 40–49 50–59 60–69 70–79 ≥80

Age	(Years)

Hypertension Prehypertension

Percent of Population 100

80

60

40

20

0

Hypertension Prehypertension

Age (Years)

18–29 30–39 40–49 50–59 60–69 70–79 ≥80

* 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.

Male Female

Black† White† Mexican-American

40

35

30

25

20

15

10

5

0

Black† White† Mexican-American

Percent of Population

Male

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

†

 Non-Hispanic.

Female
54

White† Male White† Female Black† Male Black† Female MexicanAmerican MaleMexicanAmerican

Female

1976–1980 1988–1994 1999–2002 2003–2006

60

50

40

30

20

10

0

Percent of Population

1976–1980 1988–1994 1999–2002 2003–2006

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

†

 Non-Hispanic.

Hypertension

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 

Mexican-American 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 Mexican-American females.17

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

Chart 3–68 

Hypertensive* Population Aware, Treated, and Controlled, 

Ages 18–74, U.S., 1971–1972 to 2003–2006

Chart 3–67 

Age-Adjusted Prevalence of Hypertension* by Race/Ethnicity 

and Sex, Ages 20–74, U.S., 1976–1980 to 2003–2006

1971–1972 1974–1975 1976–1980 1988–1994 1999–2002 2003–2006

Year Unaware On Medication Controlled

On Medication Uncontrolled No Medication Uncontrolled

White†

Male

White†

Female

Black†

Male

Black†

Female

MexicanAmerican 

Male

MexicanAmerican 

Female

100

80

60

40

20

0

Unaware On Medication Controlled

On Medication Uncontrolled No Medication Uncontrolled

1971–1972 1974–1975 1976–1980 1988–1994 1999–2002 2003–2006

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

Years

Percent of Hypertensive Population
55

1976–1980 1988–1991 1991–1994 1999–2002 2003–2006

Unaware On Medication Controlled

On Medication Uncontrolled No Medication Uncontrolled

Hypertension/Diseases of the Arteries

100

80

60

40

20

0

Unaware On Medication Controlled

On Medication Uncontrolled No Medication Uncontrolled

1976–1980 1988–1991 1991–1994 1999–2002 2003–2006

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

Percent of Hypertensive Population

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

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

Chart 3–69 

Hypertensive* Population Aware, Treated, and Controlled, 

Ages 18–74, U.S., 1976–1980 to 2003–2006

Chart 3–70 

Age-Adjusted Death Rates for Diseases of the Arteries 

by Race and Sex, U.S., 2006

Male Female

Total White Black

20

16

12

8

4

0

Deaths/100,000 Population

Total White Black

Male Female
56

19381940194219441946194819501952195419561958196019621964196619681970197219741976197819801982198419861988199019921994199619982000200220042006200820102012

Year

35–44 45–54 55–64 65–74 75–84 Age (Years)

Black Male White Male Black Female White Female

100

80

60

40

20

0

Black Male White Male Black Female White Female

Percent of Deaths

Age (Years)

35–44 45–54 55–64 65–74 75–84

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

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

Chart 3–72 

Percent of Deaths From Congenital Malformations 

of the Circulatory System, Age Under 1, U.S., 1940–2006

Chart 3–71 

Death Rates for Diseases of the Arteries 

by Age, Race, and Sex, U.S., 2006

120

100

80

60

40

20

0

Deaths/100,000 Population

Diseases of the Arteries/Congenital Malformations 

of the Circulatory System

1940 1950 1960 1970 1980 1990 2000 2010

Year
57

ICD-8 ICD-9 ICD-10

1970 1975 1980 1985 1990 1995 2000 2005

Year

Heart White Heart Black Other CVD White Other CVD Black

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

Chart 3–73 

Infant Mortality From Congenital Malformations 

of the Circulatory System by Race, U.S., 1970–2006

140

120

100

80

60

40

20

0

Deaths/100,000 Live Births

Congenital Malformations of the Circulatory System

1970 1975 1980 1985 1990 1995 2000 2005

Year

Heart White Heart Black Other CVD White Other CVD Black

ICD-8 ICD-9 ICD-10

59

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.)

4. Lung Diseases

Chart 4–1 

Deaths From Lung Diseases, Percent 

by Subgroup, U.S., 2006

COPD

53.6%

Other

4.1%

Cardiopulmonary

Diseases

5.5%

Neonatal

Pulmonary

Disorders

2.1%

External

Agents

8.0%

Influenza and

Pneumonia

25.0%

Asthma

1.6% Total Deaths = 225,028 (100%)
60

Lung Diseases

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 disorders446.2, 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.
61

Lung Diseases

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

In 2006, the male–female gap 

in mortality from total lung 

diseases mostly increased with 

increasing age for both blacks 

and whites.35

Chart 4–3 

Age-Adjusted Death Rates for Total Lung Diseases 

by Race and Sex, U.S., 2006

Chart 4–4 

Death Rates for Total Lung Diseases 

by Age, Race, and Sex, U.S., 2006

60

80

100

0

20

40

Total White Black

100

80

60

40

20

0

Total White Black

Deaths/100,000 Population

Male Female

400

600

800

1,000

0

200

400

35–44 45–54 55–64 65–74 75–84

Black Male White Male Black Female White Female

1,000

800

600

400

200

0

Black Male White Male Black Female White Female

Deaths/100,000 Population

35–44 45–54 55–64 65–74 75–84

Age (Years)
62

Chronic Obstructive Pulmonary Disease

From 1997 through 2007, the 

prevalence of physiciandiagnosed COPD decreased 

slightly for all age groups.24

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

Chart 4–6 

Prevalence of Chronic Obstructive Pulmonary Disease* 

by Age, Race, and Sex, U.S., 2007

Chart 4–5 

Prevalence of Chronic Obstructive Pulmonary Disease* 

by Age, U.S., 1997–2007

6

9

12

0

3

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Ages 18–44 Years Ages 45–64 Years Ages ≥65 Years

12

9

6

3

0

 Ages 18–44 Years Ages 45–64 Years Ages ≥65 Years

Percent of Population

Year

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

6

9

12

Percent of Population

0

3

18–44 45–64 ≥65

Age (Years) Black Male White Male Black Female White Female

12

9

6

3

0

 Black Male White Male Black Female White Female

Percent of Population

18–44 45–64 ≥65

Age (Years)

* Physician-diagnosed COPD only.

* Physician-diagnosed COPD only.
63

Chronic Obstructive Pulmonary Disease

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

Chart 4–7 

Hospitalization Rates for Chronic Obstructive Pulmonary Disease, 

Ages 45–64 and 65 and Older, U.S., 1995–2006

Chart 4–8 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary 

Disease by Race and Sex, U.S., 1960–2006

100

150

200

Hospitalizations/10,000 Population

0

50

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Ages 45–64 Years Ages ≥65 Years

200

150

 100 

50 

0

 Ages 45–64 Years Ages ≥65 Years

Hospitalizations/10,000 Population

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

* Nonwhite from 1960 to 1967.

40

60

80

Deaths/100,000 Population

ICD-7 ICD-8 ICD-9 ICD-10

0

20

40

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year Black* Male White Male Black* Female White Female

80

60

40

20

0

 Black* Male White Male Black* Female White Female

Deaths/100,000 Population

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

ICD-7 ICD-8 ICD-9 ICD-10 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
64

Chronic Obstructive Pulmonary Disease

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

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

Chart 4–10 

Death Rates for Chronic Obstructive Pulmonary Disease 

in White Males by Age, U.S., 1960–2006

Chart 4–9 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary 

Disease by Race/Ethnicity and Sex, U.S., 1999–2006

600

800

1,000

0

200

400

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Ages 55–64 Years Ages 65–74 Years Ages 75–84 Years Ages ≥85 Years

1,000

800

600

400

200

0

Ages 55–64 Ages 65–74 Ages 75–84 Ages ≥85 

Years Years Years Years

Deaths/100,000 Population

Year

80

Deaths/100 000 Population

60

Deaths/100,000 Population

40

20

0

1999 2000 2001 2002 2003 2004 2005 2006 1999 2000 2001 2002 2003 2004 2005 2006

Year Black* White* Hispanic Asian

80

60

40

20

0

Year

Black* White* Hispanic Asian

Deaths/100,000 Population

1999 2001 2003 2005 1999 2001 2003 2005

Male Female

* Non-Hispanic.

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

ICD-7 ICD-8 ICD-9 ICD-10
65

600

800

1,000

0

200

400

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

#REF! #REF! #REF! #REF!

Chronic Obstructive Pulmonary Disease

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

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

Chart 4–11 

Death Rates for Chronic Obstructive Pulmonary Disease 

in Black* Males by Age, U.S., 1960–2006

Chart 4–12 

Death Rates for Chronic Obstructive Pulmonary Disease 

in White Females by Age, U.S., 1960–2006

600

800

1,000

0

200

400

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Ages 55–64 Years Ages 65–74 Years Ages 75–84 Years Ages ≥85 Years

1,000

800

600

400

200

0

Ages 55–64 Ages 65–74 Ages 75–84 Ages ≥85 

Years Years Years Years

Deaths/100,000 Population

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

1,000

800

600

400

200

0

Deaths/100,000 Population

Year

* Nonwhite from 1960 to 1967.

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

ICD-7 ICD-8 ICD-9 ICD-10

ICD-7 ICD-8 ICD-9 ICD-10

Ages 55–64 Ages 65–74 Ages 75–84 Ages ≥85 

Years Years Years Years
66

Chronic Obstructive Pulmonary Disease

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

In 2003–2005, death rates for 

COPD tended to be highest in 

the Mountain States.15

Chart 4–14 

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary 

Disease by State, U.S., 2003–2005

Chart 4–13 

Death Rates for Chronic Obstructive Pulmonary Disease 

in Black* Females by Age, U.S., 1960–2006

300

400

500

600

0

100

200

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

Ages 55–64 Years Ages 65–74 Years Ages 75–84 Years Ages ≥85 Years

 500

400 

300

200

100

0

Ages 55–64 Ages 65–74 Ages 75–84 Ages ≥85 

Years Years Years Years

Deaths/100,000 Population

Year

ICD-7 ICD-8 ICD-9 ICD-10

Deaths/100,000 Population

49.1–59.0 (13) 

45.1–49.0 (12) 

39.1–45.0 (12) 

20.0–39.0 (13) 

* Nonwhite from 1960 to 1967.

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
67

Chronic Obstructive Pulmonary Disease

In 2006–2007, among 16 industrialized countries, the United 

States ranked second highest in 

COPD mortality for both males 

and females.45

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

Chart 4–15 

Age-Adjusted Death Rates* for Chronic Obstructive 

Pulmonary Disease by Country and Sex, Ages 35–74, 2007

Chart 4–16 

Age-Adjusted Death Rates for Chronic Obstructive 

Pulmonary Disease by Race/Ethnicity and Sex, U.S., 2006

40.0

50.0

60.0

0.0

10.0

20.0

30.0

Male Female

Total White* Black* Hispanic Asian

60

50

40

30

20

10

0

Total White* Black* Hispanic Asian

Deaths/100,000 Population

Male Female

NTH (2007)

CZR (2007)

NOR (2006)

EW (2007)

POL (2006)

DEN (2006)

ROM (2007)

USA (2006)

SCO (2007)

Female Male

60 40 20 0 20 40 60

JPN (2007)

FRA (2006)

ITA (2006)

SWE (2006)

KOR (2006)

GER (2006)

FIN (2007)

( 00 )

Deaths/100,000 Population

Female Male

SCO 

USA†

ROM 

DEN†

POL†

EW 

NOR†

CZR 

NTH 

FIN 

GER †

KOR†

SWE†

ITA †

FRA†

JPN 

60 40 20 0 20 40 60

Female Male

Deaths/100,000 Population

* Age-adjusted to European standard.

†

 Data for 2006.

* Non-Hispanic.
68

Chronic Obstructive Pulmonary Disease/Asthma

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

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

Chart 4–18 

Prevalence of Asthma Ages Younger Than 18 and 

18 and Older, U.S., 1980–2007

Chart 4–17 

Death Rates for Chronic Obstructive Pulmonary 

Disease by Age, Race, and Sex, U.S., 2006

12

16

Prevalence of Asthma, U.S., 1980-2007

lifetime prevalence

0

4

8

1980 1985 1990 1995 2000 2005

Ages <18 Years Ages ≥18 Years Ages <18 Years Ages ≥18 Years

12-month period prevalence

attack prevalence

16

12

8

4

0

Percent of Population

Year

1980 1985 1990 1995 2000 2005

300

400

500

600

Deaths/100,000 Population

0

100

200

35–44 45–54 55–64 65–74 75–84

Age

Black Male White Male Black Female White Female

600

500

400

300

200

100

0

Black Male White Male Black Female White Female

Deaths/100,000 Population

35–44 45–54 55–64 65–74 75–84

Age (Years)

12-month period prevalence

Attack prevalence

Current prevalence

Lifetime prevalence

 Ages <18 Years Ages ≥18 Years
69

12

16

Prevalence	of	Asthma	by	Race,	U.S.,	1980-2007

0

4

8

1980 1985 1990 1995 2000 2005

12-month period prevalence Lifetime Prevalence Attack Prevalence Current Prevalence

Asthma

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 

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 non-Hispanic 

whites and Hispanics.26–28 

Chart 4–19 

Prevalence of Asthma by Race, 

U.S., 1980–2007

Chart 4–20 

Prevalence of Current Asthma by Race/Ethnicity and 

Sex, Ages Younger Than 18, U.S., 2006

Percent of Population

Year

8

12

16

0

4

Male Female

Total Black* White* Hispanic

16

12

8

4

0

Percent of Population

Male Female

16

12

8

4

0

12-month period prevalence

Current prevalence

Lifetime prevalence

1980 1985 1990 1995 2000 2005

Attack prevalence

* Non-Hispanic.

Total Black* White* Hispanic

* Non-Hispanic.

Black* White*
70

Asthma

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 nonHispanic whites than in 

Hispanics.26–28 

From 1990 to 2006, the number 

of physician office visits for 

asthma was erratic with no obvious trend.44

Chart 4–22 

Physician Office Visits for Asthma, 

U.S., 1990–2006

Chart 4–21 

Prevalence of Current Asthma by Race/Ethnicity 

and Sex, Ages 18 and Older, U.S., 2006

15

20

Physician Office Visits (Millions)

Number (Millions)

0

5

10

1990 1995 2000 2005

Year

20

15

10

5

0

Physician Office Visits (Millions)

1990 1995 2000 2005

Year

12

16

Prevalence	of	Current	Asthma	by	Ages	18	and	Over,	Race/Ethnicity,	and	Sex,	U.S.,	2006

Percent of Population

0

4

8

Male Female

Total Black* White* Hispanic

Percent of Population 16

12

8

4

0

Male Female

Total Black* White* Hispanic

* Non-Hispanic.
71

Asthma

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 

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

Chart 4–23 

Hospitalizations for Asthma by Primary and Secondary 

Diagnosis, U.S., 1980–2006

Chart 4–24 

Hospitalizations for Asthma by Age, 

U.S., 1980–2006

800

1,200

1,600

Hospitalizations (Thousands)

0

400

800

1980 1985 1990 1995 2000 2005

Primary Diagnosis Secondary Diagnosis

1,600

1,200

800

400

0

 Primary Diagnosis Secondary Diagnosis

Hospitalizations (Thousands)

1980 1985 1990 1995 2000 2005

Year

20

30

40

0

10

1980 1985 1990 1995 2000 2005

Ages <15 Years Ages 15–44 Years Ages 45–64 Years Ages ≥65 Years

Hospitalizations/10,000 Population 40

30

20

10

0

1980 1985 1990 1995 2000 2005

Year

 Ages <15 Years Ages 15–44 Years Ages 45–64 Years Ages ≥65 Years
72

Asthma

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

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

Chart 4–26 

Age-Adjusted Death Rates for Asthma by Race 

and Sex, Ages 1–24, U.S., 1980–2006

Chart 4–25 

Age-Adjusted Death Rates for Asthma 

by Race and Sex, U.S., 2006

2

3

4

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

Deaths/100,000 Population

0

1

2

Male Female

Total Black* White* Hispanic Asian

Deaths/100,000 Population

2

3

Deaths/100,000 Population

ICD-9 ICD-10

0

1

1980 1985 1990 1995 2000 2005

Year

Black Male White Male Black Female White Female

3

2

1

0

Black Male White Male Black Female White Female

Deaths/100,000 Population

1980 1985 1990 1995 2000 2005

Year

4

3

2

1

0

Male Female

Total Black* White* Hispanic Asian

* Non-Hispanic.

ICD-9 ICD-10
73

Asthma

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

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

Chart 4–27 

Age-Adjusted Death Rates for Asthma 

by Race and Sex, U.S., 1980–2006

Chart 4–28 

Death Rates for Asthma by 

Age, Race, and Sex, U.S., 1999–2006

3

4

5

6

Deaths/100,000 Population

ICD-9 ICD-10

0

1

2

1980 1985 1990 1995 2000 2005 Year

Black* Male White Male Black* Female White Female

5

4

3

2

1

0

Deaths/100,000 Population

6

8

10

12

Death	Rates	for	Asthma	by	Age,	Race,	and	Sex,	U.S.,	1999-2006

Deaths/100,000 Population

0

2

4

1-4 5-9 10-14 15-19 20-24 25-34 35–44 45–54 55–64 65–74 75–84

Age	(Year) Black Male White Male Black Female White Female

12

10

8

6

4

2

0

Deaths/100,000 Population

Age (Year)

1–4 5–9 10–14 15–19 20–24 25–34 35–44 45–54 55–64 65–74 75–84

Black Male White Male Black Female White Female

1980 1985 1990 1995 2000 2005

Year

ICD-9 ICD-10

Black Male White Male Black Female White Female
74

Asthma/ Neonatal Respiratory Distress Syndrome

In 2006–2007, among 15 countries, the United States ranked 

ninth for males and fourth for 

females for asthma mortality.45

Infant mortality for RDS 

declined steeply from 1974 to 

1981, followed by a slow but 

appreciable decline through 

2006.31, 32

Chart 4–29 

Age-Adjusted Death Rates* for Asthma 

by Country and Sex, 2007

EW (2007)

NOR (2006)

DEN (2006)

SCO (2007)

ROM (2007)

GER (2006)

POL (2006)

Rates/100,000 Population

NTH (2007)

ITA (2006)

JPN (2007)

SWE (2006)

CZR (2007)

USA (2006)

FIN (2007)

FRA (2006)

POL†

GER†

ROM

SCO 

DEN†

NOR†

EW

FRA†

USA†

FIN 

CZR 

SWE†

JPN 

ITA†

NTH 

 4 3 2 1 0 1 2 3 4 

Female Male

Deaths/100,000 Population

* Age-adjusted to European standard.

†

 Data for 2006.

Chart 4–30 

Infant Mortality Rate for Respiratory Distress 

Syndrome, U.S., 1968–2006

150

200

250

300

Deaths/100,000 Live Births

0

50

100

150

1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

300

250

200

150

100

50

0

Deaths/100,000 Live Births

1965 1970 1975 1980 1985 1990 1995 2000 2005

Year
75

Neonatal Respiratory Distress Syndrome

From 1980 to 2006, infant 

mortality for RDS decreased appreciably in blacks and whites, 

with rates remaining higher in 

blacks.31, 32

Chart 4–31 

Infant Mortality Rate for Respiratory Distress 

Syndrome by Race, U.S., 1980–2006

120.0

140.0

160.0

180.0

200.0

Infant	Mortality	Rate	for	Respiratory	Distress	Syndrome	by	Race

0.0

20.0

40.0

60.0

80.0

100.0

1980 1985 1990 1995 2000 2005

Year

Black White

200

160

120

80

40

0

Deaths/100,000 Live Births

1980 1985 1990 1995 2000 2005

Year

 Black White

40

60

Deaths/100,000 Live Births

0

20

All Black Hispanic Central and 

South 

American

White† MexicanAmericanAsian Pacific 

Islanders

Chart 4–32 

Infant Mortality Rate for Respiratory Distress 

Syndrome by Race/Ethnicity,* U.S., 2005

60

40

20

0

Deaths/100,000 Live Births

All Black Hispanic Central White† Mexican- Asian

and South American Pacific

American Islanders

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

* No data for American Indians and Puerto Ricans.

† Non-Hispanic.
76

Sudden Infant Death Syndrome

In 2005, mortality for SIDS 

was highest in American Indians 

and lowest in Asian Pacific 

Islanders.48

Chart 4–33 

Infant Mortality Rate for Sudden Infant Death 

Syndrome by Race/Ethnicity, U.S., 2005

* No data for Central and South Americans.

† Non-Hispanic.

60

80

100

120

Deaths/100,000 Live Births

0

20

40

60

All American 

Indian

Black White† Puerto 

Rican

MexicanAmericanHispanic Asian 

Pacific 

Islanders

120

100

80

60

40

20

0

Deaths/100,000 Live Births

All American Black White† Puerto Mexican- Hispanic Asian

	 Indian	 	 	 Rican	 American	 	 Pacific

 Islanders
77

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

Aplastic Anemia

10.0%

Sickle Cell Anemia

5.2%

Other Diseases of Blood 

and Blood-Forming 

Organs

20.4%

Hemochromatosis

2.4%

Diseases of White

Blood Cells

4.9%

Purpura and Other

Hemorrhagic

Conditions

9.1%

Coagulation Defects

19.1%

Other Anemias

29.0%

Total Deaths = 9,050 (100%)
78

Blood Diseases

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%.
79

Primary Diagnosis Secondary Diagnosis

Aplastic Anemia

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

200

150

100

50

0

Number (Thousands)

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

Total White Black

1.0

0.8

0.6

0.4

0.2

0.0

Deaths/100,000 Population

* Average annual rates.

1980 1985 1990 1995 2000 2005

Year

Male Female

Total White Black
80

1.5

2.0

2.5

3.0

0.0

0.5

1.0

Black Male White Male Black Female White Female

Aplastic Anemia/Sickle Cell Anemia

Chart 5–5 

Death Rates* for Aplastic Anemia 

by Age, Race, and Sex, U.S., 2003–2006

3.0

2.5

2.0

1.5

1.0

0.5

0.0

35–44 45–54 55–64 65–74 75–84

Age (Years)

Deaths/100,000 Population

Chart 5–6 

Hospitalization Rates for Sickle Cell Anemia in Blacks, 

Ages Younger Than 15 and 15–44, U.S., 1982–2006

* Average annual rates.

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

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

50

40

30

20

10

0

Hospitalizations/10,000 Population

1980 1985 1990 1995 2000 2005

Year

 Ages <15 Years Ages 15–44 Years

Black Male White Male Black Female White Female
81

Sickle Cell Anemia

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

2.0

1.5

1.0

0.5

0.0

Deaths/100,000 Population

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

3

2

1

0

Deaths/100,000 Population

* Average annual rates.

* Average annual rates.

1980–1984 1985–1989 1990–1994 1995–1998 1999–2002 2003–2006

Year

Male Female

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

Age (Years)

Black Male Black Female

83

Appendixes

A. International Classification of Diseases

B. Estimated Comparability Ratios

C. Definition of Terms

D. Abbreviations

E. References

85

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.

87

Appendix B

Estimated Comparability Ratios for 

Selected Causes of Death, U.S. 

Codes of the Classification of International Diseases Number of Deaths* Comparability 

Ratio† Cause of Death ICD-10 ICD-9 ICD-10 ICD-9

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.

89

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.
90

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
91

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.
92

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
93

Appendix E

References

1. National Heart, Lung, and Blood Institute. Incidence and Prevalence: 2006 Chart Book on 

Cardiovascular and Lung Diseases. Bethesda, MD: National Institutes of Health; 2006.

2. National Center for Health Statistics and Centers for Medicare and Medicaid Services. International 

Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Hyattsville, MD: 

National Center for Health Statistics. Available at: http://www.cdc.gov/nchs/about/otheract/icd9/

abticd9.htm.

3. World Health Organization. International Statistical Classification of Diseases and Related Health 

Problems. Tenth Revision. Geneva: World Health Organization; 1992.

4. Kozak LJ. Underreporting of Race in the National Hospital Discharge Survey. Hyattsville, MD: 

National Center for Health Statistics; 1995. Advance Data From Vital and Health Statistics, No. 

265. Available at: http://www.cdc.gov/nchs/data/ad/ad265.pdf.

5. National Center for Health Statistics. National Hospital Discharge Survey: Annual Summary 1988. 

Hyattsville, MD: National Center for Health Statistics; 1991. Vital and Health Statistics, Series 13, 

No. 106; 1991.

6. Rosenberg HM, Maurer JD, Sorlie RD, et al. Quality of Death Rates by Race and Hispanic Origin: 

A Summary of Current Research, 1999. Hyattsville, MD: National Center for Health Statistics; 

1999. Vital and Health Statistics, Series 2, No. 128. Available at: http://www.cdc.gov/nchs/data/

series/sr_02/sr02_128.pdf.

7. Tolson GC, Barnes JM, Gay GA, Kowaleski JL. The 1989 Revision of the U.S. Standard 

Certificates and Reports. National Center for Health Statistics; 1991. Vital and Health Statistics, 

Series 4, No. 28. Available at: http://www.cdc.gov/nchs/data/series/sr_04/sr04_028.pdf.

8. Minino AM, Anderson RN. Documentation for the Public Use Multiple Cause of Death File on 

Comparability Between ICD-9 and ICD-10: A Double-Coded File Based on the 1996 Data Year 

Multiple Cause of Death File. National Center for Health Statistics. May 2004. This file was provided to NHLBI in May 2004.

9. Cheeseman JD. Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 

1995 to 2050. Washington, DC: U.S. Bureau of the Census; 1996. Current Population Reports, 

Series P-25, No. 1130. Available at: http://www.census.gov/prod/1/pop/p25-1130/p251130a.pdf.

10. Anderson RN, Rosenberg HM. Age-Standardization of Death Rates: Implementation of the Year 

2000 Standard. Hyattsville, MD: National Center for Health Statistics; 1998. National Vital Statistics 

Reports. Vol. 47, No. 3. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.pdf.
94

Appendix E

References (continued)

11. Hoyert DL, Anderson RN. Age-Adjusted Death Rates: Trend Data Based on the Year 2000 Standard 

Population. Hyattsville, MD: National Center for Health Statistics; 2001. National Vital Statistics 

Reports, Vol 49, No. 9. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_09.pdf.

12. World Health Organization. World Health Statistics Annual. Geneva: World Health Organization; 

1998.

13. Kleinman JC. State Trends in Infant Mortality, 1968-83. Am J Public Health. 1986;76(6):681-687.

14. Rogot E, Sorlie PD, Johnson NJ, Schmitt C. A Mortality Study of 1.3 Million Persons by 

Demographic, Social, and Economic Factors: 1979-85 Follow-Up. U.S. National Longitudinal 

Mortality Study. Bethesda, MD: National Institutes of Health; 1992. NIH Publication No. 92-3297.

15. Centers for Disease Control and Prevention. Compressed Mortality File: Underlying Causes of 

Death, Mortality for 1979–1998 With ICD 9 Codes and Mortality for 1999–2006 With ICD 10 

Codes. Available at http://wonder.cdc.gov/mortSQL.html.

16. Sorlie PD, Gold EB. The Effect of Physician Terminology Preferences on Coronary Heart 

Disease Mortality: An Artifact Uncovered by the Ninth Revision ICD. Am J Public Health.

1987;77(2):148-152.

17. National Heart, Lung, and Blood Institute. Unpublished tabulation of NHANES, 1971-1975, 1976-

1980, 1988-1994, 1999-2002, 2003-2006, and extrapolation to the U.S. population, 2007.

18. Hoffman JI, Kaplan S, Liberthson RR. Prevalence of Congenital Heart Disease. Am Heart J. 

2004;147(3):425-439.

19. Go AS. The Epidemiology of Atrial Fibrillation in Elderly Persons: The Tip of the Iceberg. Am J 

Geriatr Cardiol. 2005;14(2):56-61.

20. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral Arterial Disease Detection, Awareness, 

and Treatment in Primary Care. JAMA. 2001;286(11):1317-1324.

21. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart Disease and Stroke Statistics—2009 Update: 

A Report From the American Heart Association Statistics Committee and Stroke Statistics 

Committee. Circulation. 2008;119:e21-e181. Available at: http://circ.ahajournals.org/cgi/reprint/

CIRCULATIONAHA.108.191261.

22. National Heart, Lung, and Blood Institute. Extrapolation to the U.S. population from unpublished 

data received in 2007 from the Atherosclerosis Risk in Communities Study (Surveillance) and the 

Cardiovascular Health Survey.
95

Appendix E

References (continued)

23. National Heart, Lung, and Blood Institute. Extrapolation to the U.S. population from unpublished 

data of the Greater Cincinnati/Northern Kentucky Stroke Study received from Dr. Joseph Broderick 

in 2007.

24. National Health Interview Survey, 2007, Hyattsville, MD: National Center for Health Statistics. 

Unpublished data tabulated by NHLBI, 2009.

25. Mannino DM, Homa DM, Akinbami LJ, et al. Chronic Obstructive Pulmonary Disease 

Surveillance—United States, 1971–2000. MMWR. 2002;51(SS06):1-16. Available at: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5106a1.htm.

26. Bloom B, Cohen RA. Summary Health Statistics for U.S. Children: National Health Interview 

Survey: 2007. Hyattsville, MD: National Center for Health Statistics; 2009. Vital and Health 

Statistics, Series 10, No. 239. Available at: http://www.cdc.gov/nchs/data/series/sr_10/sr10_239.pdf.

27. Pleis JR, Lucas JW. Summary Health Statistics for U.S. Adults: National Health Interview Survey: 

2007. Hyattsville, MD: National Center for Health Statistics; 2009. Vital and Health Statistics,

Series 10, No. 240. Available at: http://www.cdc.gov/nchs/data/series/sr_10/sr10_240.pdf.

28. National Center for Health Statistics. Early Release of Selected Estimates Based on Data From the 

2008 National Health Interview Survey. Atlanta, GA: Centers for Disease Control and Prevention; 

June 2009. Available at: http://www.cdc.gov/nchs/nhis/released200906.htm.

29. U.S. Census Bureau. National Population Estimates by Age, Sex, Race/Ethnicity. Available at: http://

www.census.gov/popest/national/asrh/files/NC-EST2007-ALLDATA-R-File16.csv.

30. U.S. Census Bureau. National Population Projections. Released 2008. Projected Population by 

Single Year of Age, Sex, Race, and Hispanic Origin for the United States: July 1, 2000 to July 1, 

2050. Available at: http://www.census.gov/population/www/projections/downloadablefiles.html.

31. Heron M, Hoyert DL, Murphy SL, et al. Deaths: Final Data for 2006. Hyattsville, MD: National 

Center for Health Statistics; 2006. National Vital Statistics Reports. Vol 57, No. 4, Table 7. Available 

at: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf.

32. National Center for Health Statistics. Data Warehouse, Mortality Tables. Available at:

http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs.htm.

33. National Center for Health Statistics. National Hospital Discharge Survey. Hyattsville, MD: 

National Center for Health Statistics; 1970–2007. Vital and Health Statistics. Series 13. Available at: 

http://www.cdc.gov/nchs/products/series.htm#sr13.
96

Appendix E

References (continued)

34. National Center for Health Statistics. 2006 National Hospital Discharge Survey. Hyattsville, MD: 

National Center for Health Statistics; 2008. National Health Statistics Reports. No. 5. Available at: 

http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf.

35. National Heart, Lung, and Blood Institute. Unpublished tabulations of public use mortality statistics 

for 2006. Available at: http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm.

36. National Center for Health Statistics. Health Data Interactive. Available at: http://www.cdc.gov/

nchs/hdi.htm.

37. National Center for Health Statistics. Health, United States, 2008. Hyattsville, MD: National Center 

for Health Statistics; 2008. Available at: http://www.cdc.gov/nchs/hus.htm.

38. Hodgson TA, Cohen AJ. Medical Care Expenditures for Selected Circulatory Diseases: 

Opportunities for Reducing National Health Expenditures. Med Care. 1999;37(10):994-1012.

39. Rice DP, Hodgson TA, Kopstein AN. The Economic Costs of Illness: A Replication and Update. 

Health Care Financ Rev. 1985;7(1):61-80.

40. Max W. University of California at San Francisco. Unpublished Table of Present Value of Lifetime 

Earnings by Age and Sex, U.S., 2005. Personal communication in 2009.

41. Centers for Medicare and Medicaid Services. Table 2: National Health Expenditures Amounts, 

and Average Annual Percent Change by Type of Expenditure: Selected Calendar Years 2003-2018.

Available at: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2008.pdf.

42. U.S. Census Bureau. Historical Income Tables—People. Table P39. Full-Time, Year-Round All 

Workers by Mean Earnings and Sex: 1960-2007. Available at: http://www.census.gov/hhes/www/

income/histinc/p39AR.html.

43. National Center for Health Statistics. The National Nursing Home Survey: 2004 Overview. 

Hyattsville, MD: National Center for Health Statistics; 2009. Vital and Health Statistics, Series 13, 

No. 167. Available at: http://www.cdc.gov/nchs/data/series/sr_13/sr13_167.pdf. 

44. National Heart, Lung, and Blood Institute. Unpublished tabulations of the National Ambulatory 

Medical Care Survey, National Center for Health Statistics. Available at: http://www.cdc.gov/nchs/

datawh/ftpserv/ftpdata/ftpdata.htm.

45. National Heart, Lung, and Blood Institute. Unpublished tabulations from the World Health 

Organization Web site on mortality. Accessed June 2009. Available at: http://www3.who.int/

whosis/menu.cfm. 
97

Appendix E

References (continued)

46. Klebba, AJ. Mortality From Diseases Associated With Smoking: United States, 1960-77. 

Hyattsville, MD: National Center for Health Statistics; 1982. Vital and Health Statistics, Series 20, 

No. 17. Available at: http://www.cdc.gov/nchs/data/series/sr_20/sr20_017.pdf.

47. Matthews TJ. National Center for Health Statistics. Unpublished tabulation of infant death rates for 

neonatal RDS, 2005. Personal communication in 2009.

48. Matthews TJ, MacDorman MF. Infant Mortality Statistics From the 2005 Period Linked Birth/

Infant Death Data Set. Hyattsville, MD: National Center for Health Statistics; 2008. National Vital 

Statistics Report, Vol 57, No. 2. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr57/

nvsr57_02.pdf.

The bar graph on the front cover depicts

the four leading causes of death in 2006:

HEART DISEASE, cancer, STROKE, and

COPD AND ALLIED CONDITIONS.