Leading Causes of Death in Childhood Have Changed

In 1900, pneumonia and influenza, tuberculosis, and enteritis with diarrhea were the three leading causes of death in the United States, and children under 5 accounted for 40 percent of all deaths from these infections (CDC, 1999a). Today, only pneumonia (in combination with influenza) is among the top 10 causes of death overall or for children. Substantial declines in mortality have continued in recent decades. During the past 40 years, infant deaths due to pneumonia and influenza fell from 314 per 100,000 live births in 1960 to 8 per 100,000 in 1999 (Singh and Yu, 1995; NCHS, 2001b). As infectious disease mortality has declined in significance, unintentional and intentional injuries have emerged as leading causes of death, especially for children past infancy.

In 1960, infant deaths from short gestation/low birth weight and congenital anomalies (described in federal reports as “congenital malformations, deformations, and chromosomal abnormalities”) occurred at rates of 457 and 361 per 100,000 live births, respectively (Singh and Yu, 1995). By 1999, these rates had dropped to 111 and 138 per 100,000, respectively (NCHS, 2001b).

More recently, mortality from sudden infant death syndrome (SIDS), which was first reported as a separate cause of death in 1973, has dropped substantially—by more than a third between 1992 and 1996, with continuing decreases since then (Willinger et al., 1998; NCHS, 2000b). SIDS is still, however, the third leading cause of infant death in this country.

Children Have Different Patterns of Mortality Than Adults

As shown in Table 2.1 (which uses broader age categories than those used later in this chapter) the leading causes of death differ considerably for children compared to adults, especially elderly adults. For infants, the leading causes of death include congenital anomalies (a highly diverse group of malformations and other conditions), disorders related to short gestation and low birth weight, and sudden infant death syndrome. For older children and teenagers, mortality from unintentional and intentional injuries grows in importance. Among adults, as age increases, the relative contribution of injuries decreases, and death rates related to chronic conditions such as heart disease increase sharply. Beginning in adolescence, increasing age also brings increases in causes of death linked to individual behaviors involving diet, exercise, smoking, alcohol use, and similar factors.

Figure 2.1 shows the percentages of all deaths in childhood accounted for by leading causes of child mortality. Table 2.2 shows the proportion of all deaths for given age groups accounted for by the top five leading causes of death. For most age groups, a few causes of death account for two-thirds



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