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Update: Mortality Attributable to HIV Infection Among Persons Age 25 to 44 Years--United States, 1994

Update: Mortality Attributable to HIV Infection Among Persons Age 25 to 44 Years--United States, 1994

During the 1980s, HIV infection emerged as a leading cause of death in the United States. In 1993, HIV infections became the most important cause of death among persons age 25 to 44 years. This report updates national trends in deaths caused by HIV infection in 1994.

Provisional estimates of deaths in 1993 and 1994 were based on a 10% sample of death certificates of US residents filed in all 50 states and the District of Columbia. Demographic data were reported by funeral directors, and causes of death were reported by physicians, medical examiners, or coroners and encoded according to the International Classification of Diseases, Ninth Revision. Underlying causes of death were classified into the categories in CDC's "List of 72 Selected Causes of Death" for ranking. Rates were calculated using mid-year US population estimates, based on data compiled by the US Bureau of the Census. Information on Hispanic ethnicity and races other than white and black was unavailable in the provisional mortality data; each race includes Hispanics.

In 1994, an estimated 41,930 US residents died from HIV infection, a 9% increase over the estimated 38,500 deaths in 1993. Of the 41, 930 deaths in 1994, 3% were in individuals under age 25 years; 72% in 25 to 44 year olds; and 25% in those age 45 or older. HIV infection was the eighth leading cause of death overall, accounting for 2% of all deaths. Among persons age 25 to 44 years, HIV infection was the leading cause of death, accounting for 19% of deaths in this age group. In 1994, HIV infection became the fourth leading cause of years of potential life lost before age 65, or YPLL-65 (compared with fifth in 1993), accounting for 9% of YPLL-65 from all causes.

Among men age 25 to 44 years, HIV infection was the leading cause of death overall (23% of deaths; Figure 1) and was responsible for 20% and 32% of deaths and in white and black men in this age group, respectively. HIV infection was the third leading cause of death for all women 25 to 44 years old (11% of deaths; Figure 2), the fifth leading cause for white women in this age group (6% of deaths), and the leading cause for black women (22% of deaths).

In 1994, the death rate from HIV infection per 100,000 population among persons age 25 to 44 years was almost four times as high for black men (177.9) as for white men (47.2) and nine times as high for black women (51.2) as for white women (5.7). Compared with 1993, the rate for white men in 1994 was similar (47.5 and 47.2, respectively), and rates for the three other gender-racial groups continued to increase: The percentage increase was 13% for black men, 28% for black women, and 30% for white women (Fig 3).

Editorial Note from the CDC

This analysis of provisional mortality data for 1993 and 1994 indicates a continuing increase in HIV infection as a leading cause of death in the United States, particularly among persons age 25 to 44 years. Among persons in this age group, HIV infection became the most common cause of death for black men in 1991, for all men (all racial/ethnic groups combined) in 1992, and for white men in 1994. HIV became the third leading cause of death among women in this age group in 1994. In addition, as reflected by YPLL-65, HIV infection has become a leading cause of premature mortality.

Because this analysis was based on the underlying cause of death recorded on death certificates, the findings in this report probably underestimate the impact of HIV infection on mortality in the United States. Previous studies have indicated that, among persons age 25 to 44 years, deaths for which HIV infection was designated the underlying cause represent approximately two- thirds to three-fourths of all deaths attributable to HIV infection. The estimated number of death certificates with any mention of HIV infection (ie, underlying or nonunderlying cause) in 1994 was 48,000 (CDC, unpublished data, 1995), compared with the approximately 42,000 of certificates on which HIV was listed as an underlying cause. Based on survival analysis of cases reported to CDC through the AIDS surveillance system-which includes other sources in addition to data from death certificates-and the completeness of reporting of AIDS cases and of deaths, an estimated 55,000 to 60,000 persons with AIDS died in 1994 (CDC, unpublished data, 1995).

Trends in HIV-related mortality reflect changes in the demographic patterns of the HIV epidemic. For example, from 1993 to 1994, the death rate for HIV infection for white men age 25 to 44 years did not change, and rates for women and black men increased; in 1994, the rate for black women age 25 to 44 years surpassed that for white men in that age group. The increasing death rate for women affects the care of their children: The estimated 80,000 HIV-infected women of childbearing age who were alive in 1992 will leave approximately 125,000 to 150,000 children when they die during the 1990s. Racial differences in death rates for HIV infection probably reflect social, economic, behavioral, and other factors associated with HIV transmission risks. Such factors are being addressed through prevention efforts designed to meet the needs of specific communities.

Because of the prolonged period from initial HIV infection to onset of severe HIV disease (AIDS), recent trends in HIV-related mortality reflect trends in HIV transmission several years earlier. Similarly, trends in HIV-related mortality in several years will indicate, in part, the effectiveness of current efforts to prevent HIV infection. Despite recent increases in HIV-related mortality, decreases in the percentages of HIV-related deaths resulting from particular opportunistic infections (pneumocystosis, cryptococcosis, and candidiasis) suggest some success in the treatment and prevention of opportunistic infections resulting from HIV infection and underscore the importance of following recently published guidelines for preventing HIV-related opportunistic infections. (Single copies of this report will be available until February 16, 1997, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003 [telephone: (800) 458-5231 or (301) 217-0023).

Adapted from Morbidity and Mortality Weekly Report, vol 45, no 6, February 16, 1996.

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