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Mortality

Leading causes of death are determined by measuring how many people die and what the cause of death is. Leading causes account for the highest numbers of deaths in a given population and time period. Leading cause of death rankings are based on the underlying cause of death. There are 50 rankable causes in the United States.

In 1951, the Public Health Conference on Records and Statistics recommended that state and federal agencies responsible for identifying diseases of public health importance adopt a uniform ranking procedure using a standard list of causes of death. The procedures implemented in 1952 are essentially the same as those currently used by the Centers for Disease Control and Prevention National Center for Health Statistics; however, the cause-of-death lists have been expanded and altered over time with each subsequent revision of the International Classification of Diseases (ICD).1


1. Heron M. Deaths: Leading causes for 2010. National vital statistics reports; vol 62 no 6. Hyattsville, MD: National Center for Health Statistics. 2013., downloaded on 10/24/2014 from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf.
  • Leading causes of death are a primary measure of a geographic area's overall health status or quality of life.2
  • Cause-of-death ranking is a useful tool for understanding the impact of specific types of mortality on a community.3
  • Investigating mortality by cause is necessary for the development of prevention strategies.


2. Leading causes of death. Statistical measures and definitions. National Association for Public Health Statistics and Information Systems., downloaded on 10/24/2014 from https://naphsis-web.sharepoint.com/about/Documents/Leading_Causes_draft_Glen.pdf.
3. Heron M. Deaths: Leading causes for 2010. National vital statistics reports; vol 62 no 6. Hyattsville, MD: National Center for Health Statistics. 2013., downloaded on 10/24/2014 from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf.
Nationally, heart disease and cancer have been the first and second leading causes of death, respectively, since at least 1935. Stroke has been among the top five leading causes every year as well. Unintentional injury entered the top five leading causes of death in 1946 and chronic lower respiratory diseases entered the top five leading causes of death in 1979.4

Leading causes of death vary by time period, geographic area, age, race, ethnicity, gender, and other demographic factors. For example, the mortality burden of cancer is greater than that of heart disease in several states. In 2000, there were only two states where cancer was the leading cause of death; in 2014, there were 22.5


4. Hoyert DL. 75 years of mortality in the United States, 1935-2010 NCHS data brief, no 88. Hyattsville, MD: National Center for Health Statistics. 2012, downloaded on 10/24/2014 from http://www.cdc.gov/nchs/data/databriefs/db88.pdf.
5. Centers for Disease Control and Prevention. Changes in the Leading Cause of Death: Recent Patterns in Heart Disease and Cancer Mortality. Accessed 2/22/19 at https://www.cdc.gov/nchs/products/databriefs/db254.htm.
Mortality statistics are collected in accordance with World Health Organization (WHO) regulations, which require member nations to classify and code causes of death in accordance with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD provides basic guidance used in virtually all countries to code and classify causes of death. Effective with deaths occurring in 1999, the United States began using the 10th revision of this classification, ICD-10. The latest revision (ICD-11) began preparing for implementation in November of 2018 and will be presented at the World Health Assembly for official endorsement in May 2019.6 A major difference between ICD-11 and previous revisions is that it can be easily integrated into electronic health applications and information systems, it is fully electronic, and it was produced through unprecedented collaboration. The WHO received over 10,000 proposals in order to create a system that would be ready for release worldwide. However, the adoption process for ICD revisions is slow. Many countries are still using ICD-8 or ICD-9, and the United States only recently made the switch to ICD-10 in 2015 - 15 years after it's initial release.7

ICD also provides definitions, tabulation lists, the format of the cause-of-death section of the death certificate, and the rules for coding cause of death.

Tabulations of cause-of-death statistics are based solely on the underlying cause of death. The underlying cause is defined by the WHO as the disease or injury that initiated the chain of events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury. The underlying cause is selected from the conditions entered by the physician in the cause-of-death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, the provisions of ICD, and associated selection rules and modifications.8


6. ICD-11 Joint Linearization for Mortality and Morbidity Statistics: Project Plan 2015-2018. World Health Organization. 2018. Accessed 2/27/2019 at https://www.who.int/classifications/icd/revision/icdprojectplan2015to2018.pdf.
7. Coding disease and death. World Health Organization. 2018. Accessed 2/27/2019 at https://www.who.int/health-topics/international-classification-of-diseases.
8. Heron M. Deaths: Leading causes for 2010. National vital statistics reports; vol 62 no 6. Hyattsville, MD: National Center for Health Statistics. 2013., downloaded on 10/24/2014 from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf.

The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sun, 26 May 2019 5:00:23 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Sat, 6 Apr 2019 15:08:39 MDT