Vital Statistics System Mortality Data Research Articles

Trends in Drug Overdose Deaths by Intent and Drug Categories, United States, 1999‒2022.

Objectives. To examine trends in overdose deaths by intent and drug category to better understand the recent decrease in overdose suicides amid the overdose epidemic. Methods. We examined trends in rates of overdose deaths by intent (unintentional, suicide, or undetermined) across 9 drug categories from 1999 to 2022 using US National Vital Statistics System mortality data. Results. Unintentional overdoses involving synthetic opioids, polydrug toxicity involving synthetic opioids, psychostimulants, and cocaine increased exponentially with annual percentage changes ranging from 15.0% to 104.9% during 2010 to 2022. The death rates also increased for suicides involving these drugs, especially for psychostimulants (annual percentage change = 12.9% for 2010-2022; P < .001). However, these drugs accounted for relatively small percentages of overdose suicides. The leading drug categories among suicides were antidepressants, prescription opioids, and benzodiazepines, though these deaths have decreased or leveled off in recent years. Conclusions. Different drugs commonly involved in suicides and unintentional overdoses may contribute to their divergent trends. Public Health Implications. Amid the overdose epidemic, safe storage of medications remains a crucial strategy to prevent overdose suicides. The large increases in suicides involving psychostimulants warrant monitoring. (Am J Public Health. Published online ahead of print August 8, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307745).

Abstract 2134: Disaggregating breast cancer mortality trends in Asian American women from 2005-2020

Abstract Background: Breast cancer (BC) is the second leading cause of death among women and has disproportionately higher rates of mortality in certain racial groups, including Asian Americans (AA). While differences in BC mortality between AA and other racial groups have been identified, few studies have disaggregated nationwide AA mortality data. Methods: Using National Vital Statistics System mortality data, BC-related deaths were analyzed among AA groups (Asian Indian, Chinese, Filipina, Japanese, Korean, Vietnamese), Native Hawiian and Pacific Islanders (NHPIs), and non-Hispanic Whites (NHWs) from 2005-2020. We calculated cancer proportional mortality ratios (PMRs), age-adjusted mortality rates (AAMRs), standard mortality ratios, and used JoinPoint regression for average annual percentage change (AAPC). Results: Among 13677 AA, 522 NHPI, 501282 NHW descendants, 14.3% cancer deaths were due to BC. PMRs increased for all racial groups except Filipina. AAMRs significantly decreased in NHWs (AAPC -1.61; CI -1.70 to -1.48) while significantly increasing for aggregate AAs (AAPC 0.45; CI 0.08 to 0.94). Among AAs, Filipinas had the highest AAMR. AAMRs significantly increased for Asian Indians (AAPC 2.05; CI 1.20 to 3.46), Filipinas (AAPC 0.61; CI 0.15 to 1.46), Koreans (AAPC 2.72; CI 1.57 to 4.65) and Vietnamese women (AAPC 3.63; CI 2.26 to 6.20), but significantly decreased for Japanese (AAPC -1.41; CI -2.22 to -0.53). Conclusions: We observed heterogenous and converging BC mortality trends across AA groups. These trends elucidate which populations within the broader AA group have disproportionately higher death rates and therefore should be targeted for BC prevention protocols (e.g., Asian Indian and Filipina). Identifying such trends can also help elucidate disparities in cancer care and the overall social determinants that affect women with BC. Understanding disaggregated trends can inform more inclusive screening practices and culturally tailored interventions and treatments to reduce BC deaths in vulnerable populations. Citation Format: Mia Marcotte, Yashi Chauhan, Vedha Penmetcha, Caroline Thompson, Candice Thompson, Malathi Srinivasan, Gloria Kim, Xinran Qi, Robert Huang, Adrian Bacong. Disaggregating breast cancer mortality trends in Asian American women from 2005-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2134.

Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study

BackgroundRacial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover.MethodsUsing National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019).ResultsIn 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities.ConclusionUrban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.

Abstract 12190: Cardiovascular Disease Mortality Trends Among Native Hawaiian and Pacific Islander Adults—United States, 2018 to 2022

Introduction: Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in US mortality surveillance, potentially masking important differences between these two populations. In 2018, US death certificate race categories were modified, enabling the disaggregation of NHPI national CVD mortality surveillance data from the Asian population. Methods: Using National Vital Statistics System mortality data from 2018 to 2022, we identified CVD deaths among adults aged ≥35 years with ICD-10 codes I00-I99 listed as the underlying cause of death. Of all CVD decedents with non-Hispanic origin and NHPI listed alone or in combination with other race groups on the death certificate, we classified those with NHPI listed as the only race group as NHPI (60.1%). Rate ratios (RR) and 95% confidence intervals (CI) compared age-standardized mortality rates (ASMR) among NHPI adults compared to non-Hispanic Asian adults and US adults overall. Results: From 2018 to 2022, 6,088 CVD deaths (72.0% heart disease, 19.8% stroke) occurred among NHPI adults of Hawaiian (24.5%), Samoan (24.3%), Guamanian (11.0%), or other Pacific Islander (40.2%) descent. The NHPI ASMR was 464.5 CVD deaths per 100,000 (95% CI: 452.4-476.6), second only to the non-Hispanic Black ASMR (590.3 CVD deaths per 100,000, CI: 588.7-591.8; Figure). The ASMR among NHPI adults was significantly higher than non-Hispanic Asian adults (RR: 1.86, CI: 1.81-1.91) and US adults overall (RR: 1.07, 95% CI: 1.04-1.10). Conclusions: Single-race NHPI adults had the second-highest CVD death rate in the US from 2018 to 2022, second only to Black adults, and significantly higher than Asian adults. Surveillance using broader multi-race definitions to identify the NHPI population, further disaggregate by NHPI subgroup, and explore geographic variation is needed to better understand potential health disparities and target interventions to reduce CVD mortality disparities among NHPI adults.

Asthma Mortality Among Ever-Employed Persons Aged ≥15 Years, by Industry and Occupation

In 2020, an estimated 21 million (8.4%) U.S. adults had current asthma. Despite improvements in asthma management and prevention efforts, asthma deaths still occur. Approximately 11%–21% of asthma deaths might be attributable to occupational exposures. To describe asthma mortality among ever-employed persons aged ≥15 years, by industry and occupation, the 2020 National Vital Statistics System mortality data with industry and occupation information collected from 46 states and New York City were analyzed.

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities.

To examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade. We used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences. Kidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap. The largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.

Abstract WP185: Not All Asians Are Alike: Disaggregation Of Stroke Mortality Among Asian Subgroups

Background: Stroke is the 5th leading cause of death in the US. National stroke mortality among Asian subgroups has never been reported. Our objective is to disaggregate national stroke mortality data among the largest Asian American groups by sex and characterize mortality trends across a 12-year period. Methods: We extracted National Vital Statistics System mortality data from 2006 to 2017 for 6 Asian subgroups and non-Hispanic Whites (NHWs). Stroke mortality was classified by ICD-10, including ischemic stroke (I630-699), intracerebral hemorrhage (I610-629), and subarachnoid hemorrhage (I601-609). 2006-2017 American Community Survey population data was extracted to calculate age-standardized mortality rates (AMRs) stratified by sex and race. Results: Participants included 2,593 Asian Indians, 7,585 Filipinos, 8,212 Chinese, 2,551 Koreans, 3,179 Vietnamese, 4,667 Japanese, and 781,966 NHWs. Mortality from hemorrhagic strokes exceeded ischemic stroke in groups except NHW (Figure 1A). From 2006-2017, deaths from ischemic stroke increased for all groups, with higher mortality in Filipino males compared to females (figure 1B). Deaths from subarachnoid hemorrhage increased only in the Vietnamese subgroup (figure 1D). A similar trend was observed for intracerebral hemorrhage in Vietnamese males (figure 1C). Conclusion: Disaggregation of US stroke mortality revealed important variations within the 6 largest Asian subgroups, including increased ischemic stroke mortality in all subgroups and increased hemorrhagic stroke mortality among Vietnamese. Considerations for this variation include differences in risk factor prevalence (cigarette smoking, obstructive sleep apnea) and social determinants of health. Future studies must collect disaggregated Asian subgroup data to provide tailored interventions to further reduce stroke mortality. Figures: See below

Using Census Data to Understand County-Level Differences in Overall Drug Mortality and Opioid-Related Mortality by Opioid Type.

Objectives. To examine associations of county-level demographic, socioeconomic, and labor market characteristics on overall drug mortality rates and specific classes of opioid mortality. Methods. We used National Vital Statistics System mortality data (2002-2004 and 2014-2016) and county-level US Census data. We examined associations between several census variables and drug deaths for 2014 to 2016. We then identified specific classes of counties characterized by different levels and rates of growth in mortality from specific opioid types between 2002 to 2004 and 2014 to 2016. We ran multivariate and multivariable regression models to predict probabilities of membership in each "opioid mortality class" on the basis of county-level census measures. Results. Drug mortality rates overall are higher in counties characterized by more economic disadvantage, more blue-collar and service employment, and higher opioid-prescribing rates. High rates of prescription opioid overdoses and overdoses involving both prescription and synthetic opioids cluster in more economically disadvantaged counties with larger concentrations of service industry workers. High heroin and "syndemic" opioid mortality counties (high rates across all major opioid types) are more urban, have larger concentrations of professional workers, and are less economically disadvantaged. Syndemic opioid counties also have greater concentrations of blue-collar workers. Conclusions. Census data are essential tools for understanding the importance of place-level characteristics on opioid mortality. Public Health Implications. National opioid policy strategies cannot be assumed universally applicable. In addition to national policies to combat the opioid and larger drug crises, emphasis should be on developing locally and regionally tailored interventions, with attention to place-based structural economic and social characteristics.

The need to improve information on road user type in National Vital Statistics System mortality data

Objectives: Both the National Vital Statistics System (NVSS) and the Fatality Analysis Reporting System (FARS) can be used to examine motor vehicle crash (MVC) deaths. These 2 data systems operate independently, using different methods to collect and code information about the type of vehicle (e.g., car, truck, bus) and road user (e.g., occupant, motorcyclist, pedestrian) involved in an MVC. A substantial proportion of MVC deaths in NVSS are coded as “unspecified” road user, which reduces the utility of the NVSS data for describing burden and identifying prevention measures. This study aimed to describe characteristics of unspecified road user deaths in NVSS to further our understanding of how these groups may be similar to occupant road user deaths.Methods: Using data from 1999 to 2015, we compared NVSS and FARS MVC death counts by road user type, overall and by age group, gender, and year. In addition, we examined factors associated with the categorization of an MVC death as unspecified road user such as state of residence of decedent, type of medical death investigation system, and place of death.Results: The number of MVC occupant deaths in NVSS was smaller than that in FARS in each year and the number of unspecified road user deaths in NVSS was greater than that in FARS. The sum of the number of occupant and unspecified road user deaths in NVSS, however, was approximately equal to the number of FARS occupant deaths. Age group and gender distributions were roughly equivalent for NVSS and FARS occupants and NVSS unspecified road users. Within NVSS, the number of MVC deaths listed as unspecified road user varied across states and over time. Other categories of road users (motorcyclists, pedal cyclists, and pedestrians) were consistent when comparing NVSS and FARS.Conclusions: Our findings suggest that the unspecified road user MVC deaths in NVSS look similar to those of MVC occupants according to selected characteristics. Additional study is needed to identify documentation and reporting challenges in individual states and over time and to identify opportunities for improvement in the coding of road user type in NVSS.

Period life tables for the non-Hispanic American Indian and Alaska Native population, 2007-2009.

We estimated complete period life tables for the non-Hispanic American Indian and Alaska Native (AI/AN) population residing in Contract Health Service Delivery Area (CHSDA) counties for the period 2007-2009. We used National Vital Statistics System mortality data files for years 2007-2009 corrected for AI/AN misclassification on death certificates, midyear 2008 revised census bridged race intercensal population estimates, and National Vital Statistics System birth data for years 2006-2009. We used the same methodology as that used to estimate official US annual life tables, with some minor modifications. For the period 2007-2009, the non-Hispanic AI/AN population in CHSDA counties had the lowest life expectancy at birth (71.1 years) of any racial/ethnic group for which official US life tables are estimated. By comparison, in 2008, life expectancy at birth was 73.9 years for the non-Hispanic Black population, 78.4 years for the non-Hispanic White population, and 80.8 years for the Hispanic population. The life tables showed a clear mortality disadvantage for the non-Hispanic AI/AN population in CHSDA counties relative to other national populations. The findings suggested that further research is necessary to explore the causes behind these disadvantages.

American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009.

We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable.

Deaths From Residential Injuries in US Children and Adolescents, 1985–1997

The majority of deaths from unintentional injuries in children occur in the home environment, but there has not been a comprehensive analysis of residential deaths in the United States since 1985. The objective of this study was to determine the incidence and trends of deaths from injuries that occurred in the residential setting. Injury-related death rates of all deaths among US children and adolescents who were younger than 20 years from 1985 to 1997 were calculated using National Vital Statistics System Mortality Data from 1985 to 1997 by age group, gender, region, and race. Poisson regression or negative binomial regression was used to test for trends over time in mortality rates. From 1985 to 1997, an average of 2822 (55%) of 5103 annual unintentional deaths in US children with a known location of injury took place in the home environment. The annual number and incidence of fatal residential injuries decreased by >22%, from 2973 (4.2 per 100000) in 1985 to 2310 (3.0 per 100000) in 1997. The death rate as a result of residential injury was highest in children who were younger than 1 year (12.6 per 100000) and 1 to 4 years (7.9 per 100000) compared with older children, boys compared with girls (4.9 vs 2.8 per 100000), and black children compared with white children (7.0 vs 3.3 per 100000). The highest death rates were attributable to fires (1.5 per 100000), submersion or suffocation (1.3 per 100000), poisoning (0.2 per 100000), and falls (0.1 per 100000). Despite a 22% decline since 1985, residential injuries remain a leading cause of death in US children and adolescents. Black children were 2 times more likely to die from residential injuries than white children.