Stephanie Ventura of the National Center for Health Statistics was misquoted in an article yesterday on mortality and birthrate trends. What she actually said was: "We're really not sure what else is going on. Other factors associated with low birth weight, like teen births, are down." (Published 10/08/1999)
AIDS fell from the list of the leading 15 causes of death in the United States in 1998, a year that also saw a record high in life expectancy--nearly 77 years--and favorable trends in more than a half-dozen other measures of the nation's health.
The death rate from homicide dropped 14 percent, the largest decline in 40 years. Suicide decreased 6 percent and accidents 5 percent. Mortality from heart disease, cancer and stroke, the leading causes of death, continued their downward trends, according to the latest federal survey of birth and death statistics.
"We had declines in the causes where there are drugs and treatment, as well as in the ones where behavior plays a role," said Harry M. Rosenberg, chief of mortality statistics of the National Center for Health Statistics, which reported the data. "You could look at it as a banner year."
The trend in AIDS mortality, while not unexpected, is nevertheless unprecedented in vital statistics in the last half-century. The disease was the eighth-leading cause of death in 1996. By 1997, it was 14th, a reflection of the widespread use of life-prolonging "triple therapy" with antiviral drugs.
"This reflects major achievements on the part of medical science and public health prevention programs. There is simply nothing else in the trends of the last 50 years that compares with what we've seen," Rosenberg said.
The annual report also noted a reduction in the teenage birthrate, with the biggest drop--5 percent--seen in girls ages 15, 16 and 17. For women in their thirties, birthrates rose to the highest level in 30 years.
The snapshot of America's health, however, was not without shadows.
While life expectancy at birth now stands at 76.7 years (up from 76.5 in 1997), it is nearly 10 years less (67.8) for black men. For black women, it is 75 years.
The fraction of infants born with low birth weight (LBW)--a condition that increases their risk of death, mental retardation and chronic illness--was 7.6 percent, up slightly from the year before, and up from 6.8 percent in the mid-1980s. Although there was no upward trend for black women, LBW levels for them were 13 percent, nearly twice the national average.
Some of the increase in LBW infants is because of the marked rise in twins, triplets and other multiple births brought on by various fertility-enhancing treatments of the last decade. But that's unlikely to explain all of it, said Stephanie Ventura, a demographer with the National Center for Health Statistics.
"We're not really sure what else is going on. Other factors associated with low birthrate, like teen births, are down. It's very troubling," she said.
The infant mortality rate last year was 7.2 per 1,000 live births, unchanged from 1997. That compares to 3.6 in Sweden and 3.7 in Japan, the countries with the lowest rates.
The mortality rate in the District of Columbia was the nation's highest at 673 per 100,000 population, compared to an average of 471 nationwide, and 370 in Hawaii, the state with the lowest. Among states, Mississippi had the highest mortality rate, 607 per 100,000 people.
Although the decline in AIDS deaths was the most dramatic finding in the 1998 statistics, it wasn't primarily responsible for the fall in the overall mortality rate. Decreased death by heart disease, cancer and stroke--which together cause nearly two-thirds of the deaths in the United States--was the bigger driving force.
The death rate from heart disease, declining since 1950, fell 3 percent from 1997 to 1998. Cancer mortality, falling since 1990, fell 2 percent. Death from stroke, which fell after 1950 but had appeared to be leveling off early this decade, resumed a downward trend.
The proportion of births to unmarried women rose slightly, from 32.4 percent to 32.8 percent nationwide on average.