Table 1.
Mortality rates from all causes, external causes, and organ diseases in US adults aged 25-64 years (midlife), 1999-2016, by race-ethnicity (see supplemental file for detailed table, including ICD-10 codes for causes of death, data for intervening years 2000-15, nadirs, and fitted models)
| Racial-ethnic groups | Age adjusted mortality rates (deaths/100 000), by year | Changes in mortality rates | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Average absolute year-to-year changes (per 100 000)† | Proportional (%) changes | ||||||||||
| 1999 | 2016 | 1999-2016 | 2012-16 | 2016 v 1999 | 2016 v nadir¶ | Fitted model‡ | |||||
| AAPC (1999-2016) | Final APC (95% CI) | ||||||||||
| All cause mortality | |||||||||||
| NH AIAN | 439.8 | 556.8 | 6.88 | 14.82 | 26.6* | 30.8* | 1.5* | 3.4 (1.5 to 5.4)§ | |||
| NH API | 177.6 | 145.6 | −1.88 | 0.56 | −18.0* | 4.5* | −1.3* | 0.2 (−0.5 to 0.8)§ | |||
| NH blacks | 656.1 | 509.8 | −8.61 | 2.74 | −22.3* | 4.0* | −1.5* | 2.1 (−0.6 to 4.9) | |||
| NH whites | 338.9 | 356.6 | 1.04 | 4.78 | 5.2* | 8.7* | 0.2* | 1.9 (1.2 to 2.6)§ | |||
| Hispanics | 284.3 | 234.8 | −2.91 | 2.05 | −17.4* | 4.6* | −1.2* | 0.6 (−0.2 to 1.3)§ | |||
| External causes | |||||||||||
| NH AIAN | 99.8 | 157.2 | 3.38 | 6.32 | 57.5* | 66.5* | 2.5* | 2.5 (2.1 to 3.0)(NJP) | |||
| NH API | 23.6 | 22.0 | −0.09 | 0.30 | −6.8 | 13.4* | −0.5 | 0.7 (−0.5 to 1.9)§ | |||
| NH blacks | 76.6 | 94.1 | 1.03 | 4.84 | 22.8* | 38.4* | 1.3* | 12.5 (7.4 to 17.8)§ | |||
| NH whites | 52.8 | 93.6 | 2.40 | 3.82 | 77.3* | NA | 3.5* | 9.6 (4.9 to 14.6)§ | |||
| Hispanics | 47.6 | 51.4 | 0.22 | 2.03 | 7.9* | 26.5* | 0.4 | 10.0 (4.7 to 15.6)§ | |||
| Organ diseases | |||||||||||
| Diseases of the circulatory system | |||||||||||
| NH AIAN | 91.7 | 97.7 | 0.35 | 1.51 | 6.5 | 12.0* | 0.4 | 3.3 (−0.3 to 7.0)§ | |||
| NH API | 52.3 | 35.7 | −0.97 | −0.03 | −31.7* | NA | −2.1* | −0.2 (−1.1 to 0.6)§ | |||
| NH blacks | 202.1 | 147.3 | −3.22 | 0.40 | −27.1* | NA | −1.9* | 0.2 (−0.1 to 0.6)§ | |||
| NH whites | 91.0 | 75.6 | −0.91 | 0.41 | −17.0* | 3.2* | −1.1* | 0.6 (0.2 to 0.9)§ | |||
| Hispanics | 70.6 | 49.3 | −1.25 | −0.01 | −30.1* | NA | −2.1* | 0.4 (−1.1 to 1.8)§ | |||
| Diseases of the digestive system | |||||||||||
| NH AIAN | 55.6 | 79.0 | 1.38 | 2.54 | 42.1* | 49.1* | 2.3* | 3.4 (2.5 to 4.2)§ | |||
| NH API | 5.5 | 5.7 | 0.01 | 0.05 | 2.9 | NA | −0.3 | −0.3 (−0.8 to 0.1)(NJP) | |||
| NH blacks | 28.6 | 19.6 | −0.53 | −0.24 | −31.4* | NA | −2.4* | −1.1 (−1.8 to −0.3)§ | |||
| NH whites | 17.6 | 22.6 | 0.30 | 0.36 | 28.8* | NA | 1.6* | 2.1 (2.0 to 2.3) | |||
| Hispanics | 24.9 | 21.6 | −0.20 | −0.06 | −13.5* | NA | −0.8* | 0.0 (−0.4 to 0.3)§ | |||
| Diseases of the respiratory system | |||||||||||
| NH AIAN | 22.2 | 27.1 | 0.29 | 0.35 | 22.0 | 27.8* | 1.4* | 1.4 (0.5 to 2.3)(NJP) | |||
| NH API | 5.8 | 5.1 | −0.04 | 0.08 | −11.7 | 21.5* | −1.1 | 1.1 (−0.8 to 2.9)§ | |||
| NH blacks | 29.1 | 25.2 | −0.23 | 0.47 | −13.5 | 13.1* | −0.7* | 1.8 (0.0 to 3.7)§ | |||
| NH whites | 18.7 | 21.1 | 0.14 | 0.32 | 12.9* | 19.3* | 0.7* | 1.6 (0.8 to 2.5)§ | |||
| Hispanics | 10.4 | 9.5 | −0.05 | 0.17 | −8.5 | 10.9* | −0.7 | −0.7 (−1.4 to 0.1)(NJP) | |||
| Endocrine, nutritional, and metabolic diseases | |||||||||||
| NH AIAN | 31.9 | 39.4 | 0.44 | 0.97 | 23.5* | 46.3* | 1.5* | 1.5 (0.8 to 2.3)(NJP) | |||
| NH API | 6.0 | 6.8 | 0.05 | 0.19 | 15.1 | NA | 0.4 | 0.4 (0.0 to 0.7)(NJP) | |||
| NH blacks | 33.3 | 32.2 | −0.07 | 0.50 | −3.5 | 12.9 | −0.2 | 2.0 (1.1 to 2.9) | |||
| NH whites | 12.7 | 16.1 | 0.20 | 0.27 | 26.4* | NA | 1.4* | 2.5 (1.8 to 3.3)§ | |||
| Hispanics | 16.2 | 14.4 | −0.11 | 0.23 | −11.3* | 8.9* | −1.0* | 1.5 (−0.7 to 3.8)§ | |||
| Diseases of the nervous system | |||||||||||
| NH AIAN | 5.5 | 10.9 | 0.32 | 0.36 | 99.8* | 19.5* | 3.7* | 3.7 (2.7 to 4.8)(NJP) | |||
| NH API | 2.2 | 2.8 | 0.04 | 0.10 | 27.6 | 47.5 | 1.7* | 1.7 (0.9 to 2.6)(NJP) | |||
| NH blacks | 10.2 | 12.2 | 0.12 | 0.24 | 20.4* | NA | 1.0* | 1.0 (0.7 to 1.2)(NJP) | |||
| NH whites | 7.1 | 9.8 | 0.16 | 0.22 | 38.9* | NA | 1.6* | 1.6 (1.5 to 1.8)(NJP) | |||
| Hispanics | 3.7 | 5.2 | 0.09 | 0.12 | 40.4* | NA | 1.4* | 1.4 (1.0 to 1.8)(NJP) | |||
| Mental and behavioral disorders | |||||||||||
| NH AIAN | 17.7 | 17.7 | 0.00 | 0.92 | -0.1 | 51.8* | 0.9 | 7.2 (3.2 to 11.2) | |||
| NH API | 0.7 | 1.2 | 0.03 | 0.06 | 68.8 | NA | 2.3 | -0.6 (-2.8 to 1.7) | |||
| NH blacks | 9.8 | 6.5 | −0.19 | 0.15 | −33.6* | 14.5* | −2.6* | 1.7 (0.5 to 3.0)§ | |||
| NH whites | 4.6 | 7.4 | 0.17 | 0.37 | 61.1* | 51.0* | 2.7* | 5.7 (4.2 to 7.3)§ | |||
| Hispanics | 5.5 | 3.9 | −0.09 | 0.14 | −29.1* | 22.0* | −1.8 | 3.2 (0.9 to 5.4)§ | |||
| Diseases of the genitourinary system | |||||||||||
| NH AIAN | 8.1 | 10.4 | 0.14 | 0.62 | 29.0* | 42.5* | 0.4 | 0.4 (−0.7 to 1.5)(NJP) | |||
| NH API | 2.4 | 2.3 | −0.01 | 0.06 | −7.9 | NA | −0.7 | −0.7 (−1.4 to 0.0)(NJP) | |||
| NH blacks | 14.7 | 13.8 | −0.05 | 0.18 | −6.1 | 8.1 | −0.4 | 5.3 (−1.5 to 12.5)§ | |||
| NH whites | 3.4 | 4.6 | 0.07 | 0.14 | 35.7* | 18.9* | 1.8* | 5.6 (2.0 to 9.3)§ | |||
| Hispanics | 4.7 | 4.7 | 0.00 | 0.10 | −0.8 | NA | 0.2 | 4.5 (−1.3 to 10.7)§ | |||
| Pregnancy, childbirth, and the puerperium | |||||||||||
| NH AIAN | UR | UR | NA | NA | NA | NA | Insufficient data | ||||
| NH API | UR | 0.4 | NA | 0.06 | NA | NA | Insufficient data | ||||
| NH blacks | 0.6 | 1.6 | 0.06 | 0.34 | 167.9* | NA | 6.4* | 6.4 (5.6 to 7.3)(NJP) | |||
| NH whites | 0.1 | 0.6 | 0.03 | 0.12 | 411.0* | NA | 12.2* | 7.5 (4.2 to 10.9)§ | |||
| Hispanics | 0.3 | 0.5 | 0.02 | 0.15 | 101.5* | 106.3* | 3.3* | 3.3 (2.1 to 4.6)(NJP) | |||
APC=annual percentage change (slope for intervals between joinpoints); AAPC=average annual percentage change (slope for entire (1999-2016) period based on weighted average of APCs); NH=non-Hispanic; AIAN=American Indians and Alaskan Natives; API=Asians and Pacific Islanders; NA=not applicable (data inadequate for calculation); NJP=no joinpoint (fitted slope had no significant inflection during 1999-2016, values represent AAPC for 1999-2016); UR=unreliable data (<20 deaths from specified cause of death in given year and racial-ethnic group).
P <0.05.
Average year-to-year changes (from 1999 to 2016) in absolute mortality rates (deaths/100 000).
Percent increase in mortality rate relative to intervening year between 1999 and 2016 when the mortality rate reached its lowest value, which was statistically significantly below the 2016 mortality rate. Nadir years and year-by-year mortality rates are provided in table S1 of the supplemental file.
Slopes from fitted model, in which joinpoint analysis30 was used to plot trend lines that best fit the 17 annual mortality rates between 1999 and 2016. Joinpoints (see full table in the supplemental file) are points of inflection when mortality trend lines experienced a statistically significant change. For brevity, table presents APC values only for final interval ending in 2016 (or for 1999-2016 when no joinpoints were identified). (Supplemental file S1 provides the joinpoint years for each cause of death. See table S8 for all AAPC values, APC values for every segment, related 95% confidence intervals and P values, and joinpoint chartbook showing fitted model for each cause of death and racial-ethnic group.)
APC (slope) for interval ending in 2016 differed significantly (P<0.05) from slope of preceding period.