Georgia epidemiology report, Vol. 18, no. 11 (Nov. 2002)

November 2002

volume 18 number 11

Division of Public Health http://health.state.ga.us
Kathleen E. Toomey, M.D., M.P.H. Director
State Health Officer
Epidemiology Branch http://health.state.ga.us/epi
Paul A. Blake, M.D., M.P.H. Director
State Epidemiologist
Mel Ralston Public Health Advisor
Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H.
Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H.
Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer
Georgia Department of Human Resources
Division of Public Health Epidemiology Branch Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-7517
Please send comments to: Gaepinfo@dhr.state.ga.us
The Georgia Epidemiology Report is a publication of the Epidemiology Branch,
Division of Public Health, Georgia Department of Human Resources

Leading causes of death in Georgia
Introduction
Cause-of-death rankings show the most frequently occurring causes of death and their relative burden (1). We examined death data for Georgia residents who died in the years 1996 through 2000 to identify leading causes of death by age, sex, and race.
Methods
We examined death certificate data provided by physicians, coroners, medical examiners, and funeral directors for Georgia residents who died in 1996 through 2000. We categorized underlying causes of death according to lists published by the National Center for Health Statistics (NCHS) for tabulation of mortality statistics (2). We determined leading causes for all Georgia residents dying in the year 2000. For leading causes by age, sex, and race, we used a 5-year period (1996 through 2000) because of possible random variation by year.
Since 1999, causes of death listed on death certificates have been coded according to the Tenth Revision of the International Classification of Diseases (ICD-10); deaths from 1996 to 1998 were coded using ICD-9 codes. To account for coding differences in ICD-9 and ICD-10, we multiplied the number of deaths in 1996 through 1998 by the appropriate comparability ratio to get the "comparability modified" number of deaths and added these to the actual number of deaths in 1999 and 2000 (3).
Finally, we calculated age-adjusted mortality rates for the top 10 leading causes in Georgia in 2000 to compare state death rates to US rates, using the year 2000 projected population as the standard population.
Results
Death certificates were submitted for 63,657 Georgia residents who died in 2000. The two top causes, heart disease and cancer, accounted for 50% of all deaths (Figure 1). The 15 leading causes accounted for 82% of all deaths.
Leading causes of death in 1996 through 2000 varied by age (Table 1). For age groups 1 to 4, 5 to 14, 15 to 24, and 25 to 34 years, unintentional injuries were the leading cause. Homicide was the second or third leading cause of death in each of these age groups; suicide ranked sixth, third, and fourth for the 5 to 14, 15 to 24, and 25 to 34 year age groups. Unintentional injuries,

Figure 1:

Leading causes of death, Georgia, 2000 (N=63,657)

Heart disease Cancer S trok e
Unintentional injury Chronic respiratory
Diabetes Influenza/pneumonia
Alzheimer's Kidney disease
Septicemia S uicide HIV
Hypertension Homicide
Chronic liver

4534 3141 3043 1483 1426 1280 1279 1139 844 733 678 655 630

13628

18002

0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 Number of deaths
Source: Georgia death certificates

Table 1: Leading causes of death in Georgia, by age group, 1996-2000*

Rank

<1 yr n=5,269**

1-4 yrs n=890

5-14 yrs n=1,321

15-24 yrs n=5,191

25-34 yrs n=7,822

35-44 yrs n=15,370

45-54 yrs n=25,014

55-64 yrs n=36,803

65-74 yrs n=60,338

75-84 yrs n=80,419

85+ yrs n=65,019

All ages N=303,456

Congenital

1 malformation

Injury

Injury

937

350

652

Short gestation/

2

LBW

Congenital

Cancer

914

74

142

3

SIDS

Homicide

Homicide

559

59

73

4 Resp distress

Cancer

Heart

257

47

60

5 Maternal complic

Heart

Congenital

174

45

52

6

Injury

161

7 Bacterial sepsis

156

Septicemia 25
Anemia 17

Suicide 35
Benign tumor 20

8 Atelectasis Flu/Pneumonia

150

17

Necrotizing

Stroke 14

9 enterocolitis 127
Neonatal 10 hemorrhage
124

HIV

Chronic lung

17

14

Benign tumor Flu/Pneumonia

11

13

Placenta, cord, membrane

Septicemia

124

13

Injury 2,382

Injury 2,060

Cancer 2,636

Cancer 6,959

Homicide 875
Suicide 605
Cancer 235 Heart 216 HIV 102
Congenital 58
Stroke 43

HIV 1,183 Homicide 876 Suicide 836 Cancer 683 Heart 619 Stroke 143 Diabetes 102

Heart 2,511 Injury 2,290 HIV 1,933 Suicide 939 Homicide 690 Stroke 575 Chronic liver 411

Heart 6,234 Injury 1,781 Stroke 1,336 HIV 950 Chronic liver 771 Suicide 720 Diabetes 606

Diabetes 32

Septicemia 90

Diabetes 283

Chronic lung 533

Benign tumor Flu/pneumonia Flu/pneumonia Septicemia

30

77

210

350

Cancer 12,417

Cancer 18,632

Heart 25,997

Heart 24,464

Heart 88,671

Heart

Heart

Cancer

Stroke

Cancer

10,569

17,867

16,883

6,990

65,496

Stroke

Chronic lung

Stroke

Cancer

Stroke

1,912

4,250

7,178

6,856

22,195

Chronic lung

Stroke Chronic lung Flu/pneumonia Injury

1,707

3,950

5,168

2,813

15,177

Injury

Diabetes Flu/pneumonia Alzheimer's Chronic lung

1,171

1,727

2,235

2,622

14,168

Diabetes 1,083
Chronic liver 733

Injury 1,275 Chronic kidney 1,034

Alzheimer's 2,071
Diabetes 1,952

Chronic lung Flu/pneumonia

2,251

7,082

Chronic kidney Diabetes

1,486

6,933

Septicemia 562

Septicemia Chronic kidney Septicemia

1,027

1,695

1,441

Septicemia 5,391

Chronic kidney Flu/pneumonia

556

958

Injury 1,691

Injury 1,362

Chronic kidney 5,310

Suicide 422

Chronic liver Septicemia Atherosclerosis Alzheimer's

633

1,634

1,174

5,231

* Data reflect the actual number of deaths in 1999-2000 and the comparability-modified number of deaths for 1996-1998 | ** Actual number of deaths in age group, 1996-2000, including deaths that are not in the top 10 causes

Chronic kidney=Nephritis, nephrotic syndrome and nephrosis

Heart=Diseases of the heart

Placenta, cord, membrane=Complications of placenta, cord, membrane

Chronic liver=Chronic liver disease and cirrhosis

Injury=Unintentional injury, including motor vehicle accidents

Resp distress=Respiratory distress of newborn

Chronic lung=Chronic lower respiratory diseases

LBW=Low birth weight

SIDS=Sudden infant death syndrome

Congenital=Congenital malformation

Maternal complic=Maternal complications of pregnancy

homicide, and suicide accounted for 74% of deaths in the 15 to 24 year age group. Cancer and heart disease were the top two causes for all age groups from 35 to 44 years through 65 to 74 years. These two causes accounted for >50% of deaths in the 45 to 54, 55 to 64, 65 to 74, and 75 to 84 year age groups.
Leading causes of death in 1996 through 2000 varied by sex (Table 2). Injury was the third leading cause in men but only the fifth leading cause in women. HIV, suicide, and homicide ranked sixth, seventh, and tenth for men but were not in the top 10 for women. Alzheimer's ranked eight for women but was not in the top 10 for men.
For blacks who died in 1996 through 2000, HIV and homicide ranked fifth and eighth, respectively, but neither were in the top 10 for whites dying during this period (Table 3). Chronic lung disease (largely attributable to smoking) was fourth for whites but only tenth for blacks. Flu and pneumonia, Alzheimer's, and suicide were sixth, seventh, and ninth for whites but not in the top 10 for blacks.

We compared age-adjusted mortality rates for the top 10 leading causes of death in Georgia in 2000 to age-adjusted rates for the US. For eight of the 10 leading causes, the age-adjusted rate was higher in Georgia than in the US (Figure 2).
Discussion
Cause-of-death rankings show the relative burden of causes of death among those causes eligible to be ranked (1). Most of the top 15 leading causes of death in year 2000 in Georgia were chronic diseases and injuries (unintentional and intentional). This scenario is very different from that in 1900, when the top three causes in the US were pneumonia and influenza, tuberculosis, and diarrhea (4).
Grouping causes of death differently may produce different rankings (1). We used rankable causes published by NCHS to be consistent with national rankings. Some causes are not eligible to be ranked because they are subsumed in broader categories (e.g. motor vehicle accidents could be a leading cause but they are included in unintentional injuries).

Table 2:

Leading causes of death, Georgia residents, 1996-2000, by sex

Males

Females

Leading causes
All causes
1. Disease of the heart 2. Cancer 3. Injury 4. Stroke 5. Chronic lung 6. HIV 7. Suicide 8. Flu/pneumonia 9. Diabetes 10. Homicide

No. Leading causes deaths 151,351 All causes

42,994 34,910
9,737 8,675 7,588 3,581 3,448 3,180 2,987 2,452

1. Disease of the heart 2. Cancer
3. Stroke 4. Chronic lung 5. Injury 6. Diabetes 7. Flu/pneumonia 8. Alzheimer's 9. Septicemia 10. Chronic kidney

No. deaths 152,105
45,672 30,586 13,519 6,579 5,440 3,946 3,900 3,736 3,157 2,973

Table 3:

Leading causes of death, Georgia residents, 1996-2000, by race

Whites

Blacks

Leading causes
All causes
1. Disease of the heart 2. Cancer 3. Stroke 4. Chronic lung 5. Injury 6. Flu/pneumonia 7. Alzheimer's 8. Diabetes 9. Suicide 10. Septicemia

No. Leading causes deaths 219,163 All causes

66,161 48,807 15,870 12,238 10,907 5,495 4,568 4,362 3,633 3,331

1. Disease of the heart 2. Cancer 3. Stroke 4. Injury 5. HIV 6. Diabetes 7. Chronic kidney 8. Homicide 9. Septicemia 10. Chronic lung

No. deaths 82,573
22,292 16,458 6,229 4,180 3,393 2,551 2,197 2,089 2,054 1,900

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Figure 2: Age-adjusted death rates, Georgia and the US, 2000

Heart disease

Cancer Stroke Unintentional injury Chronic resp iratory Diabetes Influenza/p neumonia Alzheimer's Kidney disease Sep t icemia

60.8 73.4
35.5 41.6 44.3 48.4
25.2 22.8 23.7 23.5 18.0 22.0 13.5 20.3 11.4 18.0

201.0 205.8

257.9 286.0
US GA

References
1. Anderson RN. Deaths: Leading causes for 2000. National vital statistics reports; vol 50 no. 16. Hyattsville, Maryland: National Center for Health Statistics. 2002.
2. National Center for Health Statistics. ICD-10 Causeof-death lists for tabulating mortality statistics, effective 1999. NCHS instruction manual, part 9. Hyattsville, Maryland: National Center for Health Statistics. 1997.
3. Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD-9 and ICD-10: Preliminary estimates. National vital statistics reports; vol 49, no. 2, Hyattsville, Maryland: National Center for Health Statistics. 2001.
4. Leading causes of death, 1900-1990. NCHS DataWarehouse, Historical data, NCHS website: http://www.cdc.gov/nchs/ datawh/statab/unpubd/mortabs/hist-tabs.htm.

0

50

100

150

200

250

300

350

400

Age-adjusted death rate (per 100,000 population)

Data sources for Georgia rates: Georgia death certificates (deaths) and US Census Bureau (population) US rates taken from National Vital Statistics Reports 2002;50(15):8

A combination of frequency, ages of those affected, and preventability of the leading causes of death must all be considered when determining priorities for intervention. Most of Georgia's top 15 causes in 2000 have agreed-upon prevention strategies. Legislators and public health programs must work together to reduce deaths from leading causes in Georgia.

This article was written by Kristen Mertz, M.D., M.P.H., Manxia Wu, M.D., M.P.H., and Ken Powell, M.D., M.P.H. The authors thank the Vital Records Office and the Office of Health Information and Policy for compiling mortality data for Georgia.
For information on leading causes of death in the United States, see CDC's website ( http://www.cdc.gov/nchs/releases/02facts/ final2000.htm )

Addendum: months.

Influenza vaccination for children, including healthy young children age 6-23

The September 2002 (Vol.18, no.9) issue of the Georgia Epidemiology Report discussed Influenza Surveillance in Georgia and included recommendations for influenza vaccination for the 2002-2003 influenza season. In that issue, Table 1 lists target groups for annual influenza vaccination, including children aged >6 months who have certain medical conditions. In addition to these high-risk children, for whom annual vaccination is strongly recommended, vaccination of healthy children 6 months-23 months is encouraged when feasible because they are at increased risk for influenza-related hospitalization. Hospitalization rates among children aged 0-1 years are comparable to rates among persons aged >65 years.

The current influenza vaccine is not approved by the U.S. Food and Drug Administration (FDA) for use among children aged <6 months, the pediatric group at greatest risk for influenza-related complications. Vaccinating household contacts and out-of-home caretakers of children 0-23 months might decrease the probability of influenza among these children, and is encouraged, particularly for contacts of children aged 0-5 months.
For children aged <9 years who have not been immunized previously, two doses should be administered >1 month apart for satisfactory antibody responses. If possible, the second dose should be administered before December. To this end, vaccination should begin in October for children with certain medical conditions, household contacts of infants aged <6 months who are not eligible for influenza vaccine, healthy children aged 6-23 months, and children aged 6 months to <9 years receiving influenza vaccine for the first time.

For more vaccine information, please go to http://www.health.state.ga.us/programs/immunization For information about the Vaccines for Children Program, please go to http://www.health.state.ga.us/programs/immunization/vfc/index.shtml. For ACIP Recommendations for Prevention and Control of Influenza, please go to MMWR 2002 No. 51 (RR-03), 1-31, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5103a1.htm#tab3
Table: Influenza vaccine* dosage, by age group--United States, 2002-2003 season

Age group 6-35 months 3-8 years >9 years

Dose 0.25 mL 0.50 mL 0.50 mL

Number of doses 1 or 2 1 or 2 1

Route Intramuscular Intramuscular Intramuscular

*Vaccines manufactured by Aventis Pasteur (Fluzone split) and Wyeth Lederle (Flushield split) are FDA approved for use among persons aged >6 months. Vaccine manufactured by Evans Vaccines, Ltd. (Fluvirin purified surface antigen vaccine) is approved for use among persons aged >4 years. Two doses administered >1 month apart are recommended for children aged <9 years who are receiving influenza vaccine for the first time.

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The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186

PRESORTED STANDARD U.S. POSTAGE
PAID ATLANTA, GA PERMIT NO. 4528

November 2002

Volume 18 Number 11

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for August 2002

Selected Notifiable Diseases
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for August 2002
2002 54
1723 8 4
101 1017
1 26 1 1 0 0 0 1 0 186 79 3 23 37 11 0 30

Previous 3 Months Total

Ending in August

2000

2001 2002

234

260

182

7851

8742

7094

76

51

30

27

17

19

369

277

252

5384

5110

4077

12

13

12

108

311

95

94

107

76

2

4

2

0

1

0

7

5

5

0

1

0

18

8

3

1

0

0

710

650

616

86

98

321

33

35

22

80

93

68

132

141

125

197

193

82

7

6

0

172

116

125

Previous 12 Months Total

Ending in August

2000

2001 2002

665

637

567

27594

31631

32008

189

151

134

54

32

56

1355

1051

871

18746

18736

17802

77

97

100

336

811

616

288

422

396

10

13

11

0

1

1

61

51

42

3

8

3

61

25

16

1

0

0

1903

1608

1763

297

335

1354

131

106

84

287

298

253

570

569

612

716

818

627

24

22

13

661

581

566

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.

** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

AIDS Profile Update

Report Period
Latest 12 Months: 10/01-09/02 Five Years Ago: 10/97-09/98 Cumulative: 07/81-09/02

Total Cases Reported* <13yrs >=13yrs Total

2

1,778 1,780

5

1,312 1,317

212

25,273 25,485

Percent Female
25.3
18.8
17.7

MSM
40.4 41.5 47.6

IDU
7.1 19.3 17.4

Risk Group Distribution (%) MSM&IDU HS Blood

2.4

13.7

2.0

5.8

16.4

1.0

5.4

13.4

1.9

Unknown
34.4 16.1 14.3

Race Distribution (%) White Black Other

18.6 76.4

5.0

23.5 74.2

2.4

34.1 63.5

2.4

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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