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The following report is from a February 1996 article in the Encarta Yearbook.
A federal study released on January 17, 1996, shows that the death rate due to infectious diseases increased 58 percent overall in the United States from 1980 to 1992. Researchers at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, made the discovery through a review of all death certificates issued during those years. The dramatic increase vaulted infectious diseases to third place among leading killers of Americans, behind heart disease and cancer.
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The new report, published in the Journal of the American Medical Association, is part of a global effort to call attention to the threat of emerging and reemerging infectious diseases. More than 200 related articles were published in January in 36 journals in 21 different countries. One recurring theme is the need for increased surveillance and further study of infectious diseases.
In the United States, diseases are tracked through a global system called the International Classification of Diseases, Ninth Revision (ICD-9). According to the CDC research team led by Dr. Robert Pinner, the ICD-9 code has made it difficult for scientists to assess the overall impact of infectious diseases because the code confines many infectious diseases to specific organ systems. For example, an infection of the heart called endocarditis is classified as a disease of the cardiovascular system; otitis media, or ear infection, is classified as a disease of the ear; and pneumococcal meningitis, a brain infection, is classified as a disease of the central nervous system.
To get a comprehensive view of the impact of infectious diseases in the United States, Pinner and his colleagues evaluated each ICD-9 code to determine if it represented an infectious disease or was the consequence of an infectious disease. The government scientists then analyzed cause-of-death data for the period 1980 to 1992 that included information from 2,175,613 filed death certificates of U.S. residents.
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The data revealed that deaths due to infectious diseases as an underlying cause rose overall from 41 per 100,000 in 1980 to 65 per 100,000 in 1992—a 58 percent increase. When researchers took into account the aging of the U.S. population and adjusted the figures, they found infectious disease mortality had actually risen 39 percent.
CDC scientists found that a main culprit contributing to the increase was Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immune Deficiency Syndrome (AIDS). During the 12-year span studied, deaths due to HIV occurred for the first time in the United States and increased to 13 per 100,000. Without HIV, the overall increase in infectious disease deaths from 1980 to 1992 would have been 22 percent rather than 58 percent. (See the September 1995 Feature “AIDS: A Global Perspective” for more information on AIDS.)
Another major contributor was respiratory tract infections, which increased 20 percent, from 25.1 per 100,000 to 30.3 per 100,000 during the 12-year period. In 1992 alone, deaths due to such causes accounted for 47 percent of all infectious disease deaths. The increase can be largely attributed to the aging of the population, researchers explained, since respiratory tract infections occur principally in older age groups. Most deaths in this category were due to pneumonia, an acute or chronic disease marked by inflammation of the lungs and caused by viruses, bacteria, or other microorganisms. But researchers do not know to what extent antibiotic resistance and other factors may have affected the numbers.
Septicemia, a condition characterized by the rapid multiplication of bacteria and their toxins in the bloodstream, also contributed to the rise. Deaths due to this bloodstream infection increased by 83 percent during the 12-year span, from 4.2 per 100,000 to 7.7 per 100,000. The reasons for the jump in the number of septicemia cases are not clearly understood, researchers said.
By age group, the death rate increased most dramatically among 25- to 44-year-olds, from 6 deaths per 100,000 in 1980 to 88 deaths per 100,000 in 1992, mostly due to HIV. Among those aged 65 years and older, in whom the highest death rates occur, there was a 25 percent increase in the rate of infectious disease deaths. No increase was seen in deaths among individuals aged 5 to 24, and a drop was seen among newborns and toddlers, from 28 per 100,000 in 1980 to 20 per 100,000 in 1992.
The new report dashes the historical prediction that the occurrence of infectious diseases would dwindle in this country, Pinner said. He and his colleagues said they hoped their report would send a wakeup call to U.S. public policy makers about the need to commit more resources to studying and monitoring infectious disease trends.
Source: Encarta Yearbook, February 1996.
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Human Disease; Centers for Disease Control and Prevention; Medicine; Public Health; Infection
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