APPENDIX B
Mortality Statistics

OVERALL CAUSES OF DEATH

Overall causes of death in men and women in 2006, not adjusted for age, are presented in Table B-1. The committee used the information from these tables to identify those diseases that cause the greatest mortality in women and those that affect more women than men. Heart disease and cancer each accounted for close to one-fourth of deaths in women in the United States in 2006. They were the leading causes of death in US women residents and in US residents overall in 2006, the year on which most recent data are available. Heart disease led to more deaths in women in 2006 than did cancer, and slightly more women than men died of heart disease in that year. Men were somewhat more likely than women to die of cancer. Men and women differed substantially with respect to deaths due to stroke and unintentional injuries: stroke was the third-leading cause of death in women in 2006 (and accounted for almost 30,000 more deaths in women than in men), and unintentional injuries (for example, those due to motor-vehicle crashes and firearms) were the third-leading cause of death in men. Suicide was the seventh-leading cause of death in men but was not among the 10 leading causes of death in women. More than 4% of deaths in women and 1.7% of deaths in men were due to Alzheimer’s disease; the difference may be attributable in part to women’s longer life expectancy.

With respect to causes of death in younger women, unintentional injury was the leading cause of death in young women 15–34 years old in 2006, and homicide and suicide were the second- and third-leading causes of death in young women 15–24 years old. Cancer and heart disease were other major causes of death in young women in 2006. Human immunodeficiency virus (HIV) was



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appendix B Mortality Statistics OVERALL CAUSES OF DEATH Overall causes of death in men and women in 2006, not adjusted for age, are presented in Table B-1. The committee used the information from these tables to identify those diseases that cause the greatest mortality in women and those that affect more women than men. Heart disease and cancer each accounted for close to one-fourth of deaths in women in the United States in 2006. They were the leading causes of death in US women residents and in US residents overall in 2006, the year on which most recent data are available. Heart disease led to more deaths in women in 2006 than did cancer, and slightly more women than men died of heart disease in that year. Men were somewhat more likely than women to die of cancer. Men and women differed substantially with respect to deaths due to stroke and unintentional injuries: stroke was the third-leading cause of death in women in 2006 (and accounted for almost 30,000 more deaths in women than in men), and unintentional injuries (for example, those due to motor-vehicle crashes and firearms) were the third-leading cause of death in men. Suicide was the seventh-leading cause of death in men but was not among the 10 leading causes of death in women. More than 4% of deaths in women and 1.7% of deaths in men were due to Alzheimer’s disease; the difference may be attributable in part to women’s longer life expectancy. With respect to causes of death in younger women, unintentional injury was the leading cause of death in young women 15–34 years old in 2006, and ho - micide and suicide were the second- and third-leading causes of death in young women 15–24 years old. Cancer and heart disease were other major causes of death in young women in 2006. Human immunodeficiency virus (HIV) was 

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 WOMEN’S HEALTH RESEARCH TABLE B-1 Leading Causes of Female and Male Deaths in the United States in 2006 (estimated number of deaths, estimated percentage of deaths) a Rank Females Males 1 Heart disease Heart disease (315,930, 25.8%) (315,706, 26.3%) 2 Malignant neoplasm (cancer) Malignant neoplasm (cancer) (269,819, 22%) (290,069, 24.1%) 3 Cerebrovascular disease (stroke) Unintentional injury (82,595, 6.7%) (78,941, 6.6%) 4 Chronic lower respiratory disease Chronic lower respiratory disease (65,323, 5.3%) (59,260, 4.9%) 5 Alzheimer’s disease Cerebrovascular disease (stroke) (51,281, 4.2%) (54,524, 4.5%) 6 Unintentional injury Diabetes mellitus (42,658, 3.5%) (36,006, 3%) 7 Diabetes mellitus Suicide (36,443, 3%) (26,308, 2.2%) 8 Influenza and pneumonia Influenza and pneumonia (30,676, 2.5%) (25,650, 2.1%) 9 Nephritis (kidney inflammation) Nephritis (kidney inflammation) (23,250, 1.9%) (22,094, 1.8%) 10 Septicemia (blood poisoning) Alzheimer disease (18,712, 1.5%) (21,151, 1.8%) Total deaths 1,224,322 1,201,942 (all causes) aData are not age-adjusted. DATA SOURCE: CDC (2009a). among the 10 leading causes of death in women 15–54 years old in 2006. Women 35–44 years old, in whom HIV ranked as the fifth-leading cause of death, had the highest proportion of deaths from HIV in that year. Table B-2 summarizes the leading causes of death from cancer in women by race and ethnicity. Lung cancer and colorectal cancer were estimated to be the leading and third-leading causes of cancer deaths in both women and men in 2008 on the basis of projections from trends in cancer deaths in previous years (ACS, 2008).1 The second-leading cause of cancer deaths in women and men was 1 Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year on the basis of the most recent data on cancer in - cidence, mortality, and survival from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics.

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 APPENDIX B TABLE B-2 Leading Causes of Cancer Death in Women in the United States by Race or Ethnicity, 2006a Estimated Number (Percentage) Cancer Deaths Non- Non- Asian and American All Hispanic Hispanic Pacific Indian and Women White Black Islander Alaska Native Hispanic All cancers 269,819 219,585 30,222 5,810 1,230 12,777 Trachea, 69,385 59,723 6,622 1,081 296 1,609 bronchus, (25.7) (27.2) (21.9) (18.6) (24.1) (12.6) and lung Breast 40,821 32,114 5,631 830 160 2,054 (15.1) (14.6) (18.6) (14.3) (13) (16.1) Colon and 26,628 21,183 3,419 595 106 1,312 rectum (9.9) (9.6) (11.3) (10.2) (8.6) (10.3) aData are not age-adjusted. SOURCE: CDC (2009b). expected to be breast cancer and prostatic cancer, respectively. Lung, breast, and colorectal cancer combined were expected to account for over half the cancer deaths in women in 2008: lung cancer, 26.2%, breast cancer, 14.9%, and colorec - tal cancer, 9.5%. Pancreatic cancer and ovarian cancer were also estimated to be major causes of cancer deaths in women in 2008. Trends Heart disease, cancer, and stroke were the leading causes of deaths in women each year from 1989 to 2006 (CDC, 2001, 2009a) (Table B-3). Two notable changes over that period were the gradual decline in the proportion of deaths in women from heart disease and the increase in the proportion of deaths in women from Alzheimer’s disease. Deaths from unintentional injuries have also increased somewhat. The proportion of deaths from stroke appears to have declined from 1999 to 2006, but this change may be related partially to a disease-coding rule change that resulted in assignment to vascular dementia (International Classifica- tion of Diseases 0th Reision [ICD-0] code F01) and to unspecified dementia (ICD-0 code F03) of some deaths that previously would have been assigned to stroke (CDC, 2009b). Proportions of deaths in women from cancer of any type were very consistent, accounting for 21.6–23.3% of deaths in women each year from 1989 to 2006, whereas deaths from respiratory disease gradually increased during this period. The proportion of deaths in women from diabetes mellitus remained generally stable but its standing in the 10 leading causes of death rela - tive to Alzheimer’s disease and unintentional injuries changed. In recent years,

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TABLE B-3 Trends in Causes of Death in Women: Leading Causes of Deaths in Women, 1989–2006 00 Percentage of Deaths in Women from Given Health Outcome (Rank Among Causes of Death in Women) 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Heart disease 35.3 34.7 34.5 34.2 34 33.2 33 32.4 32 31.4 30.7 29.9 29.3 28.6 28 27.2 26.5 25.8 (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) Malignant 22.5 22.9 23.1 23.3 22.6 22.7 22.5 22.4 22.3 22 21.7 21.8 21.6 21.6 21.6 22 21.7 22 neoplasm (cancer) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) (2) Cerebrovascular 8.5 8.4 8.9 8.3 8.2 8.3 8.5 8.5 8.4 8.2 8.5 8.4 8.1 8 7.7 7.5 7 6.7 disease (stroke) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) (3) Chronic lower 3.5 3.6 3.8 3.9 4.2 4.3 4.3 4.5 4.6 4.7 5.1 5.1 5.1 5.2 5.3 5.2 5.5 5.3 respiratory diseasea (5) (5) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) (4) Diabetes mellitus 2.6 2.6 2.7 2.7 2.8 2.9 2.9 3 3 3 3.1 3.1 3.1 3.1 3.1 3.1 3.1 3 (7) (7) (7) (7) (6) (6) (6) (6) (6) (6) (5) (5) (5) (6) (6) (7) (7) (7) Influenza and 3.9 4.1 4 3.8 4.1 4 4 4 4.1 4.3 3 3 2.8 3 2.9 2.7 2.8 2.5 pneumonia (4) (4) (5) (5) (5) (5) (5) (5) (5) (5) (6) (6) (8) (8) (8) (8) (8) (8) Alzheimer’s N/A N/A N/A N/A N/A 1.1 1.2 1.3 1.3 1.3 2.6 2.9 3.1 3.4 3.6 3.9 4.1 4.2 disease (8) (8) (8) (8) (8) (8) (7) (6) (5) (5) (5) (5) (5) Unintentional 3 2.9 2.8 2.7 2.7 2.8 2.8 2.9 2.9 2.9 2.8 2.8 2.9 3 3.1 3.3 3.3 3.5 injury (6) (6) (6) (6) (7) (7) (7) (7) (7) (7) (7) (8) (7) (7) (7) (6) (6) (6) Nephritis (kidney 1 1 1 1.1 1.1 1.1 1.1 1.1 1.1 1.2 1.5 1.6 1.7 1.7 1.8 1.8 1.8 1.9 inflammation) (10) (9) (9) (8) (8) (9) (9) (9) (9) (9) (9) (9) (9) (9) (9) (9) (9) (9) Septicemia (blood 1 1 1.1 1.1 1.1 1 1.1 1.1 1.1 1.1 1.4 1.4 1.5 1.5 1.5 1.5 1.5 1.5 poisoning) (9) (10) (8) (9) (9) (10) (10) (10) (10) (10) (10) (10) (10) (10) (10) (10) (10) (10) All other causes 14 14.2 17.7 17.9 18.3 18.6 1.9 19 19.3 19.7 19.7 20.2 20.8 20.9 21.4 21.8 22.5 23.5 NOTE: The ranking of the given health outcome for cause of death in women is presented in parenthesis. N/A (not applicable) indicates that health outcome was not in top 10 leading causes of death. aChronic obstructive pulmonary diseases and allied conditions, 1989–1998. SOURCES: CDC (2001, 2009a).

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0 APPENDIX B a smaller proportion of deaths in women were due to influenza and pneumonia than during the 1990s (CDC, 2001, 2009a). Racial and Ethnic Disparities The leading causes of deaths in women differ in important ways by race and ethnicity. For instance, diabetes mellitus was the fourth-leading cause of death in non-Hispanic black, Hispanic, and American Indian and Alaska Native women and the seventh-leading cause in non-Hispanic white women in 2006 (Table B-4). Markedly higher proportions of Asian and Pacific Islander women than women in other racial and ethnic groups died from cancer (27.2% vs 22% overall) and stroke (9.5% vs 6.7% overall). American Indian and Alaska Native women expe- rienced the highest proportion of deaths due to unintentional injury (8% vs 3.5% overall). Nephritis was the cause of more than 3% of non-Hispanic black women deaths compared with 1.9% overall. There are also a number of racial and ethnic disparities in causes of cancer deaths in women. Lung, breast, and colorectal cancer were the three leading TABLE B-4 10 Leading Causes of Female Death by Race or Ethnicity, 2006 Estimated Percentage (Rank) Non- Non- Asian and American All Hispanic Hispanic Pacific Indian and Hispanica Alaska Nativeb Cause of Death Women White Black Islander Heart disease 25.8 (1) 26 (1) 25.5 (1) 22.8 (1) 22.7 (2) 18.8 (2) Malignant neoplasm 22 (2) 22 (2) 21.6 (2) 21.7 (2) 27.2 (1) 19.2 (1) (cancer) Cerebrovascular 6.7 (3) 6.7 (3) 6.8 (3) 6.4 (3) 9.3 (3) 4.9 (5) disease (stroke) Chronic lower 5.3 (4) 5.8 (4) 2.5 (7) 2.7 (6) 2.4 (7) 4.3 (6) respiratory disease Alzheimer’s disease 4.2 (5) 4.5 (5) 2.3 (9) 2.7 (7) 2.2 (8) 1.7 (10) Unintentional injury 3.5 (6) 3.5 (6) 3.1 (6) 5 (5) 3.8 (4) 8.1 (3) Diabetes mellitus 3 (7) 2.7 (7) 5 (4) 5.4 (4) 3.8 (5) 7 (4) Influenza and 2.5 (8) 2.6 (8) 2 (10) 2.6 (8) 3 (6) 2 (9) pneumonia Nephritis (kidney 1.9 (9) 1.7 (9) 3.2 (5) 2.2 (10) 2 (9) 2.4 (8) inflammation) Septicemia (blood 1.5 (10) 1.4 (10) 2.4 (8) N/A N/A N/A poisoning) NOTE: N/A (not applicable) indicates that given health outcome is not in top 10 leading causes of death in the racial or ethnic group noted. aThe ninth-leading cause of death in Hispanic females was perinatal conditions. bThe seventh-leading cause of death in American Indian and Alaska Native females was chronic liver disease and cirrhosis (4.2% of deaths in 2006). SOURCE: CDC (2009a).

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0 WOMEN’S HEALTH RESEARCH causes of cancer death in women of all racial and ethnic groups in 2006 (CDC, 2009a). However, although breast cancer was the leading cause of cancer deaths in Hispanic women in 2006, it was the second-leading cause of cancer deaths in each of the other groups (Table B-2). Asian American and Pacific Islander women had a notably lower proportion of deaths from lung cancer, perhaps because of this population’s lower prevalence of smoking.2 Lymphoma, ovarian cancer, and pancreatic cancer were also leading causes of cancer death in women in each racial and ethnic category in 2006 (CDC, 2009a). Besides breast cancer, there are notable racial and ethnic disparities in other female-specific cancers. For example, about 1.2% of cancer deaths in non- Hispanic white women in 2006 were due to cervical cancer compared with 2.1% in American Indian and Alaska Native, 2.5% in non-Hispanic black, 2.6% in Asian and Pacific Islander, and 3.6% in Hispanic women. The highest proportion of uterine-cancer deaths was in non-Hispanic black women (4% of cancer deaths vs 2.7% overall) (CDC, 2009b). A few things should be noted about changes and differences in leading causes of death in women in specific racial and ethnic populations in 1999– 2006.3 Deaths from heart disease and stroke declined in women of all racial and ethnic categories, although Asian and Pacific Islander women had the highest proportion of deaths from stroke in that period. Proportions of deaths from cancer and diabetes did not decline much in any group, but diabetes consistently led to more deaths among in American Indian and Alaska Native, non-Hispanic black, and Hispanic women than in other groups. In 1999–2002, a higher proportion of deaths in non-Hispanic black women were from HIV (the 10th-leading cause of death in non-Hispanic black women during that period) than from Alzheimer’s disease or influenza and pneumonia (which by 2006 were the 9th-leading and 10th-leading causes of death in black women). Deaths from Alzheimer’s disease have increased in each group. Deaths from unintentional injury have also gone up in general except in American Indian and Alaska Native women, in whom the proportion of deaths from unintentional injury remained relatively stable (an average of 8.4% of deaths each year in 1999–2006). REFERENCES ACS (American Cancer Society). 2008. Cancer Facts and Figures. 00. http://www.cancer.org/ acs/groups/content/@nho/documents/document/2008cafffinalsecuredpdf.pd f (accessed August 3, 2010). ALA (American Lung Association). 2008. Smoking and Asian Americans/Pacific Islanders Fact Sheet. http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=36001 (accessed April 27, 2009). 2 In 2006, 10.3% of Asian Americans, 32.2% of American Indians and Alaskan Natives, 22.6% of non-Hispanic blacks, 21.8% of non-Hispanic whites, and 15.1% of Hispanics smoked (ALA, 2008). 3 Racial and ethnic group-specific data for the period 1989–1999 are not available.

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0 APPENDIX B CDC (Centers for Disease Control and Prevention). 2001. Leading Causes of Death, 00–. http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf (accessed August 3, 2010) ———. 2009a. WISQARS Leading Causes of Death Reports, –00. http://webappa.cdc.gov/ sasweb/ncipc/leadcaus10.html (accessed April 27, 2009). ———. 2009b. Deaths: Final Data for 00. National Vital Statistics Reports. Volume 57, Number 14.

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