Table 2.
Mortality rates by leading causes of death in non-Hispanic whites aged 25-64 years (midlife), 1999-2016 (see supplemental file for detailed table, including ICD-10 codes for causes of death, data for intervening years 2000-15, nadirs, and fitted models)
| Causes of death | Age adjusted mortality rates (deaths/100 000), by year | Changes in mortality rates | Excess deaths (1999-2016) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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) | |||||||||||
| External causes | ||||||||||||
| Drug overdoses | 6.2 | 37.0 | 1.81 | 2.91 | 494.3* | NA | 11.1* | 20.0 (6.2 to 35.7)§ | 33 003 | |||
| Alcohol poisoning | 0.2 | 1.2 | 0.06 | 0.01 | 674.5* | NA | 12.3* | 2.1 (−0.5 to 4.9)§ | 1146 | |||
| Pedestrian/cyclist/motorcycle injury | 3.4 | 5.1 | 0.10 | 0.14 | 50.1* | NA | 2.4* | 9.4 (−1.4 to 21.5) | 1404 | |||
| Miscellaneous land/other transport accidentsa | 6.7 | 7.2 | 0.03 | 0.27 | 7.8* | 23.5* | 0.2 | 2.8 (1.5 to 4.0) | 561 | |||
| Other forms of accidental poisoningb | 0.3 | 0.7 | 0.02 | 0.03 | 139.1* | NA | 5.1* | 5.1 (4.2 to 6.0)(NJP) | 410 | |||
| Falls, drowning, firec | 3.7 | 4.4 | 0.04 | 0.03 | 19.4* | NA | 1.0* | 0.2 (−0.1 to 0.6)§ | 768 | |||
| Suicide | 15.6 | 23.3 | 0.45 | 0.35 | 49.4* | NA | 2.5* | 1.8 (1.0 to 2.5)§ | 8300 | |||
| Diseases of the circulatory system | ||||||||||||
| Hypertensive diseases | 3.8 | 8.8 | 0.29 | 0.36 | 129.8* | NA | 5.1* | 4.2 (3.9 to 4.6)§ | 5318 | |||
| Other heart diseased | 14.2 | 15.0 | 0.05 | 0.33 | 6.0* | 15.6* | 0.4* | 2.9 (2.1 to 3.8)§ | 916 | |||
| Venous/lymphatic diseases | 0.7 | 1.0 | 0.02 | 0.01 | 51.5* | NA | 1.3* | 1.3 (0.7 to 2.0)(NJP) | 376 | |||
| Pulmonary heart disease | 2.5 | 2.5 | 0.01 | 0.06 | 3.6 | 19.7* | 0.0 | 1.7 (0.8 to 2.5)§ | 93 | |||
| Diseases of the digestive system | ||||||||||||
| Alcoholic liver disease | 5.8 | 9.4 | 0.21 | 0.37 | 62.4* | 63.0* | 2.9* | 4.1 (3.7 to 4.5)§ | 3901 | |||
| Mental and behavioral disorders | ||||||||||||
| Mental/behavioral disorders involving psychoactive substances | 4.0 | 6.3 | 0.14 | 0.40 | 58.9* | 66.7* | 2.6* | 7.4 (5.3 to 9.5)§ | 2493 | |||
| Organic mental disorders | 0.2 | 0.6 | 0.02 | -0.03 | 185.9* | NA | 6.1* | −8.9 (−17.3 to 0.4)§ | 442 | |||
| Infectious and parasitic diseases | ||||||||||||
| Miscellaneous infectious diseasese | 3.7 | 5.7 | 0.12 | 0.14 | 53.9* | NA | 2.4* | 2.4 (2.2 to 2.7)(NJP) | 2149 | |||
| Neoplasms | ||||||||||||
| Liver cancer | 2.2 | 4.0 | 0.11 | 0.01 | 80.0* | NA | 3.7* | 0.0 (−1.3 to 1.3)§ | 1931 | |||
| Cancer of lip/oral cavity/pharynx | 1.9 | 2.1 | 0.01 | 0.04 | 10.5* | 23.5* | 0.4 | 1.8 (0.6 to 3.0)§ | 215 | |||
| Pancreatic cancer | 5.3 | 5.5 | 0.01 | 0.03 | 3.3 | 7.6* | 0.3* | 0.3 (0.2 to 0.5)(NJP) | 188 | |||
| Endocrine, nutritional, and metabolic diseases | ||||||||||||
| Obesity | 1.2 | 2.7 | 0.09 | 0.08 | 124.6* | NA | 4.9* | 3.3 (2.9 to 3.7)§ | 1616 | |||
| Diabetes | 9.3 | 10.1 | 0.05 | 0.11 | 8.9* | 14.2* | 0.5* | 2.2 (1.4 to 3.0)§ | 879 | |||
| Metabolic disorders | 1.7 | 2.5 | 0.05 | 0.05 | 46.2* | NA | 2.0* | 2.0 (1.8 to 2.3)(NJP) | 858 | |||
| Miscellaneous endocrine disordersf | 0.5 | 0.6 | 0.01 | 0.01 | 31.1* | 38.9* | 1.7* | 1.7 (1.2 to 2.2)(NJP) | 154 | |||
| Diseases of the respiratory system | ||||||||||||
| Chronic lower respiratory diseases | 11.5 | 12.3 | 0.04 | 0.17 | 6.6* | 17.1* | 0.5* | 1.4 (0.9 to 1.9)§ | 835 | |||
| Lung diseases due to external agents | 0.8 | 1.3 | 0.03 | 0.04 | 60.3* | NA | 2.4* | 2.4 (2.0 to 2.8)(NJP) | 542 | |||
| Miscellaneous respiratory system disordersg | 0.8 | 2.4 | 0.09 | 0.27 | 206.5* | 252.1* | 6.3* | 37.4 (20.1 to 57.1)§ | 1709 | |||
| Diseases of the nervous system | ||||||||||||
| Alzheimer’s/degenerative disorders | 0.6 | 1.1 | 0.03 | 0.06 | 76.8* | 84.5* | 2.8* | 2.8 (2.1 to 3.4)(NJP) | 498 | |||
| Epilepsy/episodic, paroxysmal disorders | 0.6 | 1.0 | 0.02 | 0.04 | 60.6* | NA | 2.4* | 2.4 (2.0 to 2.9)(NJP) | 401 | |||
| Inflammatory diseasesh | 1.9 | 2.3 | 0.02 | −0.01 | 17.1* | NA | 0.8* | 0.8 (0.5 to 1.1)(NJP) | 353 | |||
| Cerebral palsy | 0.5 | 0.9 | 0.02 | 0.02 | 59.1* | 15.3* | 3.2* | 2.1 (1.2 to 3.1)§ | 346 | |||
| Extrapyramidal/movement disorders | 0.3 | 0.4 | 0.01 | 0.03 | 65.6* | NA | 2.0* | 2.0 (1.3 to 2.7)(NJP) | 189 | |||
| Miscellaneous peripheral diseasesi | 0.6 | 0.7 | 0.01 | 0.01 | 29.9* | 34.0* | 1.0* | 1.0 (0.4 to 1.6)(NJP) | 177 | |||
| Miscellaneous disordersj | 1.3 | 2.3 | 0.06 | 0.08 | 78.5* | NA | 3.5* | 3.3 (2.5 to 4.1) | 1084 | |||
| Diseases of the genitourinary system | ||||||||||||
| Renal failure | 2.4 | 3.2 | 0.05 | 0.08 | 33.7* | 13.5* | 1.6* | 5.3 (−2.9 to 14.2) | 865 | |||
| Other urinary system diseasesk | 0.8 | 1.2 | 0.02 | 0.06 | 43.3* | 31.6* | 1.8* | 1.8 (1.2 to 2.4)(NJP) | 385 | |||
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); 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). a=Accidents involving other land, water transport, air/space, and other/unspecified transport; b=accidental poisoning by organic solvents, halogenated hydrocarbons, other gases and vapors, pesticides, and unspecified chemicals and noxious substances; c=includes deaths from submersion, smoke, and flames; d=arrhythmias, cardiomyopathy, heart failure, cardiac arrest, myocarditis, and valvular and pericardial disease; e=intestinal infections, tuberculosis, and zoonotic and other bacterial, sexually transmitted, spirochetal, chlamydial, rickettsial, central nervous system, arthropod-borne, and viral hemorrhagic infections; f=disorders of thyroid and other endocrine glands, malnutrition, and disorders of glucose regulation and pancreatic internal secretion; g=respiratory failure, not elsewhere classified, and other respiratory disorders; h=inflammatory diseases (eg, meningitis, encephalitis) and systemic atrophies (eg, Huntington’s disease) affecting the central nervous system; i=nerve/nerve root/plexus disorders, polyneuropathies, and other disorders of the peripheral nervous system, diseases of myoneural junction and muscle; j=disorders of autonomic nervous system, hydrocephalus, toxic encephalopathy, and other disorders of nervous system, not elsewhere classified; k=glomerular and renotubular interstitial diseases, urolithiasis, and other diseases of urinary system. See supplemental file for ICD-10 codes for each cause of death.
P <0.05.
Average year-to-year changes (1999-2016) 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 S2 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 (JP) 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 S2 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.