Update: Mortality Attributable to HIV Infection Among Persons Aged 25-44 Years -- United States, 1991 and 1992

During the 1980s, human immunodeficiency virus (HIV) infection emerged as a leading cause of death in the United States (1). In 1992, HIV infection became the number one cause of death among men aged 25-44 years. This report updates national trends in deaths caused by HIV infection for 1991 and 1992.

Data are from the National Vital Statistics System and were obtained from death certificates filed in all 50 states and the District of Columbia. Cause of death was reported by attending physicians, medical examiners, and coroners; demographic characteristics were recorded by funeral directors. Data for 1992 are provisional estimates based on a 10% sample of death certificates (2); 1991 is the latest year for which final mortality data are available (3 ).

In 1992, an estimated 33,590 U.S. residents died from HIV infection; of these, 2% were aged less than 25 years; 73%, 25-44 years; and 25%, greater than or equal to 45 years. During 1992, HIV infection became the eighth leading cause of death overall (up from ninth in 1991), accounting for 1.5% of all deaths, and the second leading cause of death among persons aged 25-44 years (up from third in 1991) (16.2% of deaths). In 1992, HIV infection became the leading cause of death for men aged 25-44 years (up from second in 1991) and the fourth leading cause of death for women in this age group (up from fifth in 1991) (19.9% and 7.3% of deaths, respectively) (Table_1).

Stratified by race, HIV infection was the leading cause of death for black men aged 25-44 years during 1991 and 1992 (21.4% and 25.3% of deaths, respectively) and the second leading cause of death (preceded by unintentional injuries) for white men in that age group (17.8% in 1991 and 18.5% in 1992). HIV infection was the second leading cause of death for black women aged 25-44 years (up from third in 1991) in 1992 (12.1% in 1991 and 16.5% in 1992) and the sixth leading cause of death for white women aged 25-44 years in 1991 and 1992 (3.4% in 1991 and 3.8% in 1992). The death rate from HIV infection in 1992 for persons aged 25-44 years was three times as high for black men (136.0 per 100,000) as for white men (42.1 per 100,000) and 12 times as high for black women (38.0 per 100,000) as for white women (3.3 per 100,000).

In 1991 (the most recent year for which mortality data are available for Hispanic ethnicity and for other races), HIV infection was the leading cause of death among Hispanic men aged 25-44 years (24.1% of deaths) and the third leading cause of death among Hispanic women in this age group (12.4% of deaths). * Among Asians/Pacific Islanders, HIV infection was the sixth leading cause of death for men aged 25-44 years (8.8% of deaths) and the ninth leading cause of death for women in this age group (1.1% of deaths). Among American Indians/Alaskan Natives, HIV infection was the sixth leading cause of death for men aged 25-44 years (4.5% of deaths) and the seventh leading cause of death for women in this age group (1.9% of deaths).

The death rate from HIV infection for persons aged 25-44 years has steadily and dramatically increased during the past 10 years, compared with death rates from most other leading causes of death (Figure_1 and Figure_2). From 1982 to 1992, the rate increased from 0.6 per 100,000 to 52.8 per 100,000 for men aged 25-44 years and from 0.1 per 100,000 to 7.8 per 100,000 for women in this age group. Reported by: Surveillance Br, Div of HIV/AIDS, National Center for Infectious Diseases; Mortality Statistics Br, Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: Although these findings underscore the increasing impact of HIV infection on mortality in the United States, particularly among persons aged 25-44 years, the magnitude is greater than indicated in this report. This analysis was based on the underlying cause of death recorded on death certificates; previous studies suggest that deaths for which HIV infection is designated as the underlying cause represent approximately two thirds to three fourths of all HIV-related deaths (4,5).

HIV infection has more severely affected mortality among blacks and Hispanics than other racial/ethnic groups. These differences probably reflect social, economic, behavioral, or other factors rather than race/ethnicity directly (6). The social and cultural context of HIV infection must be addressed through prevention efforts designed to meet the needs of specific communities.

References

1. CDC. Update: mortality attributable to HIV infection/AIDS among persons aged 25-44 years -- United States, 1990 and 1991. MMWR 1993;42:481-6.

2. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Monthly vital statistics report; vol 41, no. 13).

3. NCHS. Advance report of final mortality statistics, 1991. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Monthly vital statistics report; vol 42, no. 2, suppl).

4. Buehler JW, Devine OJ, Berkelman RL, Chevarley FM. Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States. Am J Public Health 1990; 80:1080-6.

5. Buehler JW, Hanson DL, Chu SY. Reporting of HIV/AIDS deaths in women. Am J Public Health 1992;82:1500-5.

6. CDC. Use of race and ethnicity in public health surveillance: summary of the CDC/ATSDR Workshop. MMWR 1993;42(no. RR-10).

* These data exclude deaths in New Hampshire and Oklahoma, which did not include an item to identify Hispanic ethnicity on their death certificates. The data differ from data for Hispanics published by CDC's National Center for Health Statistics for 1991, which also exclude deaths in New York City (3).
Table_1
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TABLE 1. Percentage of deaths caused by HIV infection, rank of HIV infection among
all causes of death *, and death rate from HIV infection for persons aged 25-44 years,
by sex and race + -- United States, 1992 &
================================================================================================
                           Men                                     Women
         ----------------------------------------   -----------------------------------
          Total    HIV                   Death      Total    HIV                  Death
Race      deaths  deaths   (%) @   Rank   rate **   deaths  deaths  (%)     Rank   rate
---------------------------------------------------------------------------------------
White     78,310  14,460  (18.5)    2      42.1     29,580  1,120   (3.8)    6      3.3
Black     25,680   6,490  (25.3)    1     136.0     12,500  2,060  (16.5)    2     38.0

All ++   106,690  21,210  (19.9)    1      52.8     43,610  3,200   (7.3)    4      7.8
---------------------------------------------------------------------------------------
 * Based on the proportion of deaths from each of the cause categories used by CDC's National
   Center for Health Statistics to rank the 15 leading causes of death.
 + Persons of Hispanic ethnicity are included among whites and blacks. Provisional data for
   1992 were unavailable for other races.
 & Provisional data.
 @ Percentage of deaths caused by HIV infection among total deaths in the age, sex, and racial
   group.
** Per 100,000 population.
++ Includes Asians/Pacific Islanders and American Indians/Alaskan Natives.
================================================================================================

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