Happy Halloween! We thought this article appropriate for the occasion.
This is an excerpt from the following article:
CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors—United States, 2005–2013.
October 31, 2014
Leading Causes of Death
During the time reflected in this study, the list of the top 10 leading causes of death remained essentially the same (with one change), although the order has varied.
Diseases of the heart (heart disease) have long been the leading cause of death in the United States (23.7% of total deaths in 2011). Deaths attributable to heart disease have declined steadily over the last decade (3), both in the age-adjusted rate and the total number. Since 2005, the average age-adjusted rate of death from heart disease has declined by 3.54% per year, and even with a growing aging population, the average annual number of deaths has decreased by 1.4% and consistently remains below 600,000 deaths per year compared with 652,091 deaths in 2005.
The proportion of deaths attributable to malignant neoplasms (cancer) has remained stable in recent years (22.8% of total deaths in 2005 and 22.9% in 2011). The age-adjusted rate of cancer deaths in the population has declined over time (an average annual decrease of 1.44% since 2005), but the number of deaths has increased steadily as a result of general population growth (e.g., there were 17,379 more cancer deaths in 2011 than in 2005), especially among the elderly. If current trends continue, cancer will soon replace heart disease as the leading cause of death. In addition, the average relative change in YPLL annually attributable to cancer has decreased by 1.6% since 2005, or >100 years per 100,000 persons aged <75 years . This decline in YPLL could be attributed to multiple factors, including decreased cancer incidence, decreased mortality with some cancer types, or persons developing the condition later in life or living longer with cancer. Lung cancer remains the leading cause of cancer death, accounting for 27% (157,017) of the total cancer deaths in 2011. The age-adjusted rate of deaths from lung cancer has declined steadily in recent years. Furthermore, YPLL attributed to lung cancer has declined by 70 years per 100,000 population since 2005; providing the greatest contribution (nearly 50%) to the progress in YPLL for cancer overall . As with all cancers, multiple factors could account for the decrease in YPLL, including a decrease in lung cancer incidence, developing the condition later in life, or living longer with the condition. The age-adjusted death rates for female breast and colorectal cancer have each declined slightly in recent years, but the number of deaths attributed to each has remained stable, with an average of approximately 41,000 and 53,000 attributable annual deaths, respectively.
For approximately 5 decades, cerebrovascular disease (stroke) was the third leading cause of death (13). However, after years of slow, steady decline in deaths attributed to stroke, along with a corresponding increase in death from chronic lower respiratory diseases, their rankings exchanged positions in 2008, when chronic lower respiratory diseases moved up to become the 3rd leading cause of death and stroke moved from third to fourth position. Chronic lower respiratory disease is a group of conditions that includes chronic obstructive pulmonary disease (COPD), a group of diseases that cause airflow obstruction and resulting breathing-related problems. COPD includes emphysema, chronic bronchitis, and in some cases, asthma. In 2008, changes were made in how chronic lower respiratory diseases are coded and classified, which contributed at least in part to the increase in death from chronic lower respiratory diseases for 2008 (13). From 2005 to 2011, the age-adjusted death rate from chronic lower respiratory diseases ranged between 41.0 and 44.7 deaths per 100,000 population. The average decrease during this period was 0.03% per year. The number of deaths from chronic lower respiratory disease has increased, on average, by 2.0% per year. The age-adjusted rate of death from stroke decreased from 48.0 per 100,000 in 2005 to 37.9 in 2011; an average decline of 3.77% per year. The number of stroke deaths also decreased by an average of 1.7% per year, or 14,647 fewer deaths per year in 2011 compared with 2005.
The proportion of deaths attributable to unintentional injuries overall has remained stable at 4.8%–5.0% in recent years. The age-adjusted death rate for unintentional injuries has ranged from 37.5 to 40.4 per 100,000 population between 2005 and 2011, with an average annual decline of 0.77% during this time. The number of deaths has increased slowly, with 8,629 more unintentional deaths in 2011 than in 2005; an annual increase of 0.6%. Within this category, however, the age-adjusted rate and number of motor vehicle-related deaths have declined considerably, with 10,011 fewer deaths in 2011 than in 2005. Multiple factors account for this decline, including improved vehicle protection technologies, changes in behavior, injury prevention policies, and improved trauma care. Conversely, drug poisonings have increased steadily each year, with 11,527 more deaths in 2011 than in 2005. The age-adjusted rate for fatal falls among persons aged ≥65 years increased steadily between 2005 and 2011; from 42.3 to 53.7 per 100,000, while the number of deaths has increased by 7,099 during the same period. Taken together, these results suggest an increase attributable not only to the changing size of the older population but also to more older adults dying from falls.
The age-adjusted death rate for Alzheimer’s disease in recent years has remained stable, moving up and down within a range of 2 percentage points, which equates to an annual increase since 2005 of 0.78%. However, as the older population has grown, the proportion and number of deaths from Alzheimer’s disease has increased slowly and steadily. In 2007, death from Alzheimer’s disease moved up from seventh to sixth position as a leading cause of death, exchanging places with diabetes mellitus. In 2011, Alzheimer’s-attributed deaths accounted for 84,974 deaths, or 3.4% of total deaths. Even though the rate of Alzheimer’s has remained steady, this represents an increase of 13,375 deaths compared with 2005, and an average increase of 3.1% per year from 2005 to 2011. Although Alzheimer’s disease is not preventable, early diagnosis is important. Because dementia has been shown to be underreported in death certificates, the proportion of older persons who die from Alzheimer’s might be considerably higher (14).
After years of steady decline, both the age-adjusted rate and the number of diabetes deaths have increased. In 2005, the age-adjusted rate of death from diabetes mellitus was 24.9 per 100,000 population; a figure that dropped to 20.8 by 2010. In 2011, the age-adjusted rate was 21.6 per 100,000 population, but the trend from 2005 to 2011 shows an average decrease of 2.68% per year. A total of 75,119 deaths were attributed to diabetes mellitus in 2005; this figure decreased to 68,705 in 2009 and then increased again to 73,831 deaths in 2011. However, for the period overall from 2005 to 2011, the number of diabetes deaths shows an average annual decrease of 0.7%. YPLL attributed to diabetes maintained a declining trend in recent years, from 179.4 per 100,000 population in 2005 to 158.2 in 2010 (Table 1), suggesting that patients are not developing the disease until later in life or are living longer with this disease. Similar to the age-adjusted death rate, however, the YPLL attributed to diabetes increased by 5.9% in 2011 from the year before to 167.6 per 100,000 population.
Deaths from pneumonia and influenza have experienced small increases and decreases in recent years. In 2005, a total of 63,001 persons died from pneumonia and influenza. Since then, the number of annual deaths has ranged from 50,097–56,326. As a result, even though the number of deaths from pneumonia and influenza in 2011 increased by 7.4% from the year before, they still show an average decrease of 2.4% per year since 2005. The age-adjusted rate of death from pneumonia and influenza followed a similar pattern, decreasing from 21.0 per 100,000 population in 2005 to 16.8 in 2007; increasing in 2008 to 17.6, and then decreasing over the next 2 years to 15.1 in 2010. In 2011, the age-adjusted rate increased to 15.7 per 100,000, resulting in an average annual decrease of 4.49%. Each season varies regarding the severity of influenza, which populations are most heavily affected, and how well influenza vaccine provides protection from the circulating strains. During the 2009–10 influenza season, the rate and number of deaths were lower than the year before, but persons aged 25–64 years were disproportionately affected (15). As a result, YPLL attributed to pneumonia and influenza in 2009 increased by nearly 35% over the year before.
From 2005 to 2010, the age-adjusted rate of death from nephritis, nephrotic syndrome, and nephrosis (kidney disease) increased from 14.7 per 100,000 population to 15.3; and in 2011 decreased to 13.4 (a decrease of 12.4% from the year before). As a result, the average percent change from 2005 to 2011 indicates a decline of 0.70% per year. The number of deaths from all types of kidney disease had also been increasing steadily from 2005 to 2010, when it peaked at 50,476, or 2% of total deaths. The increase in 2010, concurrent with a 1-year decrease in deaths from pneumonia and influenza, resulted in a brief (1 year) exchange in their rankings (between the eighth and ninth positions) among the top 10 leading causes of death (10). In 2011, the number of kidney disease deaths decreased by 4,885 compared with 2010. This decrease in the number of deaths resulted in a 1-year decline of 9.7% but an average annual increase of 1.4% since 2005.
The age-adjusted rate and number of deaths from intentional self-harm (suicides) in the United States have increased steadily in recent years, claiming 39,518 lives in 2011, or 6,889 more than in 2005. From 2005 to 2011, the average annual increase in the age-adjusted suicide rate was 2.15%, and the average annual increase in the number of suicides was 3.4%. Suicide became the 10th leading cause of death in 2008, when it surpassed septicemia by just over 100 fatalities; since then, suicide has remained the 10th leading cause of death (13).
Selected Associated Risk and Protective Factors for Morbidity and Mortality
Seven of the top 10 leading causes of death are the result of chronic diseases, which are among the most common, costly, and preventable of all health problems in the United States (16). Heart disease and cancer alone account for nearly half of all lives lost each year. Many of these deaths, as well as those from stroke, diabetes, and other chronic illnesses could have been delayed, and quality of life could have been improved, through health promoting behaviors, including healthy diet, physical activity, avoidance of tobacco, and other types of risk reduction. For example, the success in reducing heart disease mortality has been attributed in part to implementation of evidence-based medical therapies and in equal measure to reductions in major risk factors: decreasing blood pressure and cholesterol levels through dietary changes, decreased smoking rates, and increased physical activity (17). The three remaining leading causes of death are the result of injuries (unintentional, suicide) and infectious disease (pneumonia and influenza).
The following indicators were selected because they represent core behavioral risk and protective factors that are linked causally with the leading causes of death. The indicators provided are not exhaustive for each issue area. For example, diet is represented by consumption of fruits and vegetables and by sodium intake, two priority areas for CDC that also reflect, in part, overall eating habits. However, this limited view should not diminish the importance of the other aspects of a healthy diet, as recommended in the Dietary Guidelines for Americans (18). Instead, these indicators provide a current view across an array of health issues, serving as a dashboard (i.e., a collection of data) that is used to monitor and help direct operations to prevent the leading causes of death.
Nutrition, Physical Activity, and Obesity
Approximately 78 million adults and 12 million youths in the United States are obese (19,20). The age-adjusted obesity prevalence among adults aged ≥20 years has held steady in recent years, and was nearly 35% in 2011–2012. However, given slight fluctuations over time, the change between 2005–2006 and 2011–2012 resulted in an average annual increase of 0.6%.
During 2007–2008, the percentage of children aged 2–19 years who were obese was 16.8%, a relative increase of 9% from the previous data cycle. Since then, the rate for children has remained steady at 16.9%. As a result, from 2005–2006 to 2011–2012, childhood obesity appears to have an annual average increase of 1.4%.
Physical activity among adults remains low, with only approximately one in five persons aged ≥18 years currently meeting the federal guidelines for physical activity established in 2008 (21). While this age-adjusted rate implies improvement from approximately 16.0%–17.0% from 2005–2007, it has stayed level at approximately 20.0% for the last 4 years. The average change across years is an increase of 3.8% per year.
The percentage of high school students who are physically active (defined as being active for 60 minutes per day, 7 days per week) remains low overall, with a rate of 27.1% in 2013. Historic data starting from 2005 are provided, but because of changes in the methodology for how data were collected starting in 2011, comparisons cannot be made across years. CDC will continue to monitor and report on these trends.
To examine average fruit and vegetable intake, this report measures the age-adjusted rate of intake relative to calories (i.e., cups per 1,000 calories). In 2009–2010, persons aged ≥2 years consumed an average of 0.6 cups of fruits and 0.8 cups of vegetables per 1,000 calories consumed. Daily recommendations for fruit and vegetable intake vary depending on age, sex, and level of physical activity (22,23). Because 2011–2012 data were not yet available at the time this report was prepared, no trend analysis can be provided at this time. CDC will continue to monitor and report on fruit and vegetable consumption.
All cigarette consumption is discouraged because of the extensive damage smoking does to smokers and to nonsmokers who are exposed to secondhand smoke, and on average, per capita cigarette consumption has decreased in the United States in recent years (24). In 2012, current smokers consumed an average of approximately 1,196 cigarettes, or 520 fewer cigarettes per year than in 2005. From 2005 to 2012, per capita cigarette consumption declined by an average of 5.8% per year.
After a few years of remaining level at approximately 28%, current smoking among adults decreased to a low of 24.9% in 2011, followed by a slight increase to 25.2% in 2012. This represents an average annual decline since 2005 of 2.0%. The percentage of high school students in 2013 who were current smokers was 15.7%. For youth smoking, the average change since 2005 represents a decline of 4.2% per year.
In 2011–2012, a total of 41.3% of children aged 3–11 years were exposed to the harmful effects of secondhand smoke. While still high, this is a marked improvement over the 53.6% of children exposed to secondhand smoke in 2007–2008. This represents an average decline of 4.2% per year from 2005–2006 to 2011–2012.
Heart Disease and Stroke Prevention
The prevention, treatment, and control of cardiovascular disease could be greatly increased through improvement of the ABCS (aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation) (25). This strategy is the primary focus of the Million Hearts initiative, the goal of which is to prevent 1 million heart attacks and strokes by 2017 (25).
In 2011–2012, approximately half of those with high blood pressure (46.3%) had their condition under control. While this age-adjusted rate is disappointing given the known evidence-base to prevent, detect, and control high blood pressure, it is a marked improvement over past years (e.g., 36.5% in 2005–2006). Since 2005–2006, blood pressure control has increased, on average, by 3.6% per year.
From 2005–2006 to 2009–2010, age-adjusted control of elevated LDL cholesterol increased from 22.3% to 29.5%. In 2011–2012, control of LDL cholesterol increased by 16.1% from the previous data cycle, and from 2005–2006 to 2011–2012, control of LDL cholesterol increased by an average of 4.4% per year.
Appropriate aspirin use for the prevention of heart attacks and strokes has been recommended by numerous treatment guidelines and was recognized as the most underutilized and cost-effective clinical intervention (26,27). Aspirin was ordered or continued at only approximately half (53.8% in 2010) of the office visits by patients who would benefit from aspirin use for secondary prevention (postevent or postdiagnosis). This rate is increased from previous years (e.g., 46.1% in 2005–2006), but because 2011–2012 data were not available at the time this report was prepared, the criterion for conducting trend analysis (a minimum of four data points since 2005) was not met.
Excess sodium intake can increase a person’s risk for high blood pressure (28). As of 2009–2010, average daily sodium intake was estimated to be 3,463 mg/day; well above the recommended limits provided in the 2010 Dietary Guidelines for Americans (<2,300 mg/day for all persons aged ≥2 years, or 1,500 mg per day for adults aged ≥51 years, African Americans, or anyone who has high blood pressure, diabetes, or chronic kidney disease) (18). This level of intake has changed very little in recent years. Because data are limited, trend analysis is not available at this time; CDC will continue to monitor and report on data as they become available.
Cancer Prevention and Control
With appropriate screening and early treatment, many cancer-related deaths can be prevented. In 2012, 65.1% of adults aged 50–75 years received a colorectal cancer screening that met U.S. Preventative Services Task Force guidelines (recommended frequency varies depending on the type of test); 83.8% of women ages 21–65 received a Pap test in the past 3 years, and 78.8% of women ages 50–74 received a mammogram in the past 2 years (29). Historical data from 2006 forward are provided in Table 3, but because of a change in the survey methodology in 2011, comparisons cannot be made across these data points.
In 2006, the Advisory Committee on Immunization Practices released recommendations for routine vaccination for human papilloma virus (HPV) among females aged 11–12 years to prevent spread of this virus, which is the main cause of cervical cancer (30). This recommendation stated that HPV vaccination can be given as early as 9 years and should be administered to females aged 13–26 years who had not been vaccinated previously (30). Reporting of HPV vaccination coverage (receipt of 3 or more doses) began with the 2008 cycle of CDC’s National Immunization Survey–Teen, which surveys adolescents starting at age 13 years. Among girls aged 13–15 years, a 2008 baseline of 16.6% was established for HPV vaccine. Receipt of 3 or more doses of HPV vaccine by females aged 13–15 years increased by 38% in 2009 and by nearly 25% in 2010, but remained similar during 2010–2012 (ranging between 28.1% to 30.0%) before increasing to 32.7% in 2013. While this represents an average increase of 12.3% per year, uptake of this safe and effective preventive treatment remains low.
If not properly controlled, diabetes can cause serious health complications, including heart disease, blindness, kidney failure, and lower-extremity amputations (31). Age-adjusted data collected from 2005–2008 indicated that 17.9% of persons with diabetes had a hemoglobin A1c level >9.0%, indicating that they did not have the condition under control. During 2009–2012, an estimated 21.0% of persons with diabetes did not have their condition under control. Similarly, the number of persons with diabetes who did not have their condition under control was estimated to be 2.3 million during 2005–2008 and 2.6 million during 2009–2012. However, because of the small sample sizes and margin of error in these estimates, the perceived increase might not be real. Because data are limited, trend analysis is not available at this time; CDC will continue to monitor and report on diabetes.
Asthma is often a chronic condition that causes wheezing, breathlessness, chest tightness, and coughing; and can limit quality of life. The number of annual hospitalizations attributed to asthma has varied over the last few years, with absolute increases or decreases from 1 year to the next ranging from as few as 5,000 cases to as many as 45,000 cases. In 2010, an estimated 439,000 asthma hospitalizations occurred in the United States, representing a decline of 8.4% from the year before; but an average annual decrease of only 0.9% from 2005 to 2010.
Excessive Alcohol Use
Binge drinking is associated with many health problems, including unintentional injuries (e.g., motor-vehicle crashes and falls), sexually transmitted infections, high blood pressure, stroke, and poor diabetes control (32). In 2012, more than one in four adults (27.1%) reported engaging in binge drinking (having five or more drinks of alcohol on a single occasion for men and having four or more for women) in the past 30 days. This estimate has stayed relatively constant for several years, with slight fluctuations that average out to a decline of 0.3% per year from 2008 to 2012. In 2013, a total of 20.8% of high school students reported binge drinking (males or females having five or more drinks of alcohol in a row) in the past 30 days; reflecting an annual decline of 2.9% since 2005.
Fortunately, progress has been made in recent years in reducing drinking and driving deaths. During 2005–2006, approximately 13,500 fatalities per year were attributed to alcohol-impaired driving. In 2011, a total of 9,878 fatalities were associated with drinking and driving (motor-vehicle crashes with a driver whose blood alcohol concentration was ≥0.08 g/dL). The annual average decline from 2005 to 2011 was 6.0%.
The percentage of high school students who reported engaging in drinking and driving in the past 30 days was 10.0% in 2013, up from 8.2% in 2011. On average, self-reported high school drinking and driving has decreased by 1.1% per year from 2005 to 2013.
Ebola infected cell
In 2011, one of the top 10 leading causes of death was infection from pneumonia and influenza; and other types of infectious disease were responsible for substantial morbidity and mortality. The source of infectious disease can vary. Some infectious diseases are foodborne or health-care–associated; others are spread by vectors or from person to person. Many infectious diseases can be prevented through safe food handling practices, following clinical guidelines to promote infection control in health-care settings, avoiding behaviors that result in unsafe sexual practices, and receiving recommended vaccinations. Avoiding the preventable spread of infectious disease is critically important, especially as antimicrobial resistance increases (33).
Each year, approximately 20,000 children aged <5 years are hospitalized because of influenza complications (34). In the 2009–10 influenza season, the first season for which all children aged 6 months–17 years were recommended for annual influenza vaccination, only 43.7% of children in this age group received a vaccination for seasonal influenza. Influenza vaccination coverage increased by 16.7% for this age group during the 2010–11 season, followed by a 1.0% increase for the 2011–12 season. In the 2012–13 season, an estimated 56.6% of children aged 6 months–17 years received a seasonal influenza vaccination. The average annual change in influenza vaccination of children from the 2009–10 to the 2012–13 season was an increase of 8.2%.
Starting with the 2010–11 influenza season, the recommendation to receive influenza vaccine was extended to all persons aged ≥6 months (35). Among adults aged ≥18 years, 41.5% were vaccinated for influenza in the 2012–13 season. The average annual percentage change in adult influenza vaccination coverage from the 2009–10 through the 2012–13 season was an increase of 0.4%.
To protect both health-care personnel and patients, CDC recommends that health-care personnel obtain an annual influenza vaccination (35). In 2012, an estimated 72% of health-care personnel received an influenza vaccination, indicating an average increase of 4.4% per year since 2009.
Pregnant women have an increased risk of severe complications from influenza, and therefore it is particularly important that they receive influenza vaccine (35). In 2012, an estimated 50.5% of pregnant women were vaccinated for influenza, marking a relative increase of 7.4% from the year before. Because of insufficient years of data, trend analysis is not yet available, but CDC will continue to monitor and report on receipt of this vaccine.
Foodborne illnesses are estimated to affect one in six U.S. residents each year. Consumption of contaminated food causes an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths annually (36). Norovirus is the leading cause of foodborne illness, but illness is also often spread through direct contact with infected persons in health-care settings. Exposure to contaminated food is the source for virtually all Listeria illnesses. This is also the source for most Salmonella and Shiga toxin-producing E. coli (STEC) O157 infections, but there are also other important sources for these illnesses.
The incidence of Listeria infection varied from 2005 through 2013 from 0.26 to 0.32 cases per 100,000 population. Year-to-year changes ranged from 0 to 23.1%. The average annual percent change for the period was a decrease of 0.8%.
Salmonella is the most commonly reported cause of infection and the most common cause of multistate foodborne illness outbreaks (37). The incidence rate of Salmonella infection increased from 14.53 cases per 100,000 in 2005 to 17.55 in 2010, and then decreased to the current rate of 15.19 in 2013. Yearly variation ranged from 0.5% to 16.8%, and the average annual percent change was an increase of 1.3% from 2005 to 2013.
From 2005 to 2013, the rate of Salmonella serotype Enteritidis infection ranged between 2.36 and 3.53 cases per 100,000 population. The annual percent change for the period was an increase of 3.0%, with yearly variation ranging from 0 change to 33.7%.
From 2005 to 2013, the rate of STEC O157 infection ranged between 0.95 and 1.30 cases per 100,000 population. The average percent change for the period from 2005 to 2013 was a decrease of 1.2% per year, with annual differences ranging from 2.1% to 22.6%.
Approximately 700,000 health-care–associated infections (HAIs) occurred in 2011, affecting approximately one in 25 hospitalized patients (38). HAIs, including central line–associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical-site infections (SSI), and Clostridium difficile, are reported using a standardized infection ratio (SIR). The SIR is a summary measure used to track HAIs over time. It compares actual HAI rates in a facility or state with baseline rates in the general U.S. population and adjusts for several risk factors found to be most associated with differences in infection rates. In other words, the SIR takes into account the fact that different health-care facilities treat different types of patients. For example, HAI rates at a hospital that has a large burn unit (where patients are at higher risk for acquiring infections) cannot be compared directly with a hospital that does not have a burn unit.
The standardized infection ratio for CLABSI in hospital settings has decreased steadily from a baseline of 1.00 in 2008 to 0.56 in 2012. On average, the number of observed (compared with expected) CLABSI events has decreased by 14.1% per year from 2008 to 2012.
In 2010, the national standardized infection ratio for CAUTI declined 6% from the year before (from a baseline of 1.00 to a SIR of 0.94) and declined slightly more to a SIR of 0.93 in 2011. However, in 2012, the SIR for CAUTI increased to 1.03, surpassing the baseline levels and moving the trend in an undesirable direction, raising the average increase across all years to 0.8%. The increase in 2012 indicates the need for more aggressive and focused CAUTI prevention measures, particularly in hospital intensive care units, where CAUTI SIRs are highest.
The national standardized infection ratio for hospital admission and readmission as a result of surgical-site infections (SSIs) has declined substantially from the 2008 baseline of 1.00 to 0.80 in 2012. On average, from 2008 to 2012, SSIs have declined by 5.8% per year.
While many HAIs have been declining in recent years, C. difficile has remained at historically high levels, causing severe diarrhea that has been linked with approximately 14,000 deaths per year (39). CDC began reporting the standardized infection ratio for hospital onset of C. difficile in 2011, with a baseline of 1.00. In 2012, there was a 2% reduction in the SIR to 0.98. With limited data available, trend analysis is not yet possible, but CDC will continue to monitor and report on C. difficile.
Unlike these other HAIs, the incidence of invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections has been monitored based on the infection rate per 100,000 population. From 2008 to 2012, the incidence rate of health-care–associated invasive MRSA infections declined steadily, falling from 27.08 infections per 100,000 population in 2008 to 18.74 infections per 100,000 population in 2012. This progress represents an average annual decline of 8.7% over this period.
At the end of 2010, an estimated 1.1 million persons aged ≥13 years were living with HIV infection in the United States, but on the basis of modeling estimates, approximately 16% were not aware of their infection (40).
Among the population as a whole, the number of new infections in the United States has fluctuated over the last few years. In 2007, there was an estimated increase of >4,000 new infections from the year before (up to 53,200), followed by decreases in 2008 and 2009 (down to 45,000). In 2010 (the latest year for which data are available), estimated numbers increased again, and approximately 47,500 persons in the United States were estimated to be newly infected with HIV. With this variation, the change across years nets an annual average decline of 2.1% in the number of new HIV infections among persons aged ≥13 years.
The rate at which HIV is transmitted to others among adolescents and adults has followed a similar trajectory to that of new infections, increasing from a rate of 4.6 per 100 HIV positive persons in 2006 to 4.9 in 2007, followed by 2 years of decline in 2008–2009 (down to 4.0) and a subsequent increase to 4.2 in 2010. With this fluctuating trend, the rates of HIV transmission from 2006–2010 show an average annual decrease of 3.9%.
The percentage of persons aged ≥13 years living with HIV who know their serostatus has steadily increased in recent years, from 80.9% in 2006 to 84.2% in 2010, representing an average annual increase of 1.1%.
Chlamydia infection is the most commonly reported sexually transmitted disease in the United States. Although chlamydia infection is easy to cure, it can cause complications if untreated. Most persons who have chlamydia infection are unaware that they are infected because the disease often has no symptoms (41).
From 2005 to 2009, the rate of chlamydia infection among females aged 15–19 years increased steadily, from 2,733.0 to 3,314.7 per 100,000 population. In 2010, a slight decrease of 0.5% was observed from the previous year. The rate increased by 5.6% in 2011, and in 2012 dropped by the same proportion, returning to approximately the 2010 level. With this variation, the average percent change from 2005 to 2012 was an increase of 3.3% per year.
The rate of chlamydia infection among women aged 20–24 years has demonstrated no sign of decline, with an increase of 1,027.6 diagnosed infections per 100,000 population in 2012 compared with 2005. The average increase in chlamydia rates among women aged 20–24 years was 4.9% per year. For women aged 15–19 years and 20–24 years, the observed increase in diagnosis reflects, at least in part, an increased effort to screen more women for chlamydia infection and bring more infected women in for treatment.
Hepatitis C virus infection is the most common chronic bloodborne infection in the United States (42). Since 2005, the number of new hepatitis C cases has nearly doubled to the current rate of 1,229 in 2011. From 2005 to 2011, the relative difference in new cases of hepatitis C from 1 year to the next have included a 1-year increase of 3.3%, a 1-year decrease of 10.9%, and from 2010 to 2011, an increase of 44.6%. The average change over this period shows the number of new cases of hepatitis C increasing by 6.4% per year. It should be noted, however, that a new case indicates a diagnosis, and not necessarily a new infection. On the basis of national data, persons born during 1945–1965 were identified as a high-risk population, resulting in a recommendation for one-time hepatitis C screening of all persons born in that timeframe (43,44). Although the CDC recommendations and the U.S. Preventive Services Task Force recommendations were not published until 2012 and 2013, respectively, momentum had been building previously in the clinical community to increase screening of this high-risk population. The number of deaths for which hepatitis C is listed as the cause of death has increased continually in recent years, to 17,721 deaths in 2011, representing an average increase of 6.0% per year from 2005 to 2011.
Maternal and Child Health
Improving the health and well-being of mothers, infants, and children is an important public health goal for the nation. As noted in Healthy People 2020, the well-being of mothers and their children determines the health of the next generation, impacting future public health challenges for families, communities, and the health care system (45). Although many of the indicators related to maternal and child health do not have a direct causal relationship to the leading causes of death, they all influence health status throughout the lifetime.
Infant mortality is an indicator used to measure the health and well-being of a nation, as many factors affecting the health of the entire population also can impact the mortality rate of infants (46). In 2011, the infant mortality rate in the United States dropped to a historically low value of 6.1 deaths to infants aged <1 year per 1,000 live births (11). Except for a slight increase in 2007, the number of infant deaths has gradually decreased from 28,440 in 2005 to 23,985 in 2011. The average annual change from 2005 to 2011 for infant mortality rates and number of infant deaths has shown improvement for both, decreasing by 2.1% and 3.2%, respectively.
Children of teenaged mothers are more likely than other children to have lower school achievement, have more health problems, and be incarcerated at some time during their youth (47). Following a slight increase in 2006 and 2007, the rate of teen births among females aged 15–19 years has declined steadily to a record low of 26.6 per 1,000 females in 2013 (48). The average change from 2005 to 2013 represents a decline of 5.4% per year.
Breastfeeding is an important, effective preventive action a mother can take to protect the health of her infant. Breastfeeding is recognized as the best source of nutrition for most infants and has been linked with a reduction of risk in a number of health outcomes for the child and the mother (49). The percentage of infants that are breastfed at age 6 months has increased steadily to a current rate of 49.4% in 2011. Historic data from 2005 forward are provided (Table 5); however, because of a change in the survey methodology that was made in 2009, comparisons cannot be made across these data points. Because of insufficient years of data since 2009, trend analysis is not yet available. CDC will continue to monitor and report on breastfeeding.
The vaccine schedule recommended for children is designed to provide protection from potentially serious diseases before they are likely to be exposed and when they are most vulnerable to serious infections. The percentage of children aged 19–35 months receiving universally recommended vaccines (diphtheria, tetanus, and pertussis [DTaP]; poliovirus; measles, mumps, and rubella [MMR]; Haemophilus influenzae type b [Hib]; hepatitis B [HepB]; varicella; and pneumococcal conjugate vaccine [PCV]) increased substantially from 44.3% in 2009 to 68.5% in 2011, remained stable in 2012 at 68.4%, and in 2013 increased to 70.4% (50). The average change from 2009 to 2012 represents an improvement of 11.8% per year. In addition, rotavirus vaccine was introduced for all U.S. infants in 2006, and coverage with the series among children aged 19–35 months in 2013 (those born during January 2009–May 2011) was 72.6% (50).
Coverage varies for each of the different vaccines in the series (51). During 2005–2013, vaccination coverage among children aged 19–35 months was constantly ≥90% and stable for DTaP, polio, MMR, HepB, and varicella vaccines; coverage increased for the more recently recommended PCV vaccine (50). Much of the observed increase in vaccination utilization is the result of improvement in the supply of Hib vaccine beginning in 2009, after a product shortage that had led to a 2007 recommendation from the Advisory Committee on Immunization Practices to defer the Hib booster dose for children (52). Stocks were replenished in 2011, and by 2012, fewer children for whom data were collected were affected by the shortage and a need to defer vaccination.
Lead exposure can affect nearly every system in the body (53). An estimated 4 million U.S. households have children living in them who are being exposed to high levels of lead. During 2009–2010, a total of 535,699 children in the United States aged 1–5 years had blood lead levels >5 µg/dL [micrograms of lead per deciliter of blood], the level at which CDC recommends that public health actions be initiated (53). As a result of a recent change in how childhood blood lead levels are defined and classified, trend analysis is not available at this time, but CDC will continue to monitor and report on lead poisoning.
The findings provided in this report demonstrate slow but steady progress in improving the health of the U.S. population. However, much remains to be accomplished. The age-adjusted death rate in the United States has reached an all-time low, with 740.6 deaths per 100,000 (1). The shift in leading causes of death in the United States over the last century from infectious disease such as gastrointestinal disease and tuberculosis to chronic conditions such as heart disease and cancer, as well as the decreasing death rate and increasing life expectancy, all reflect a level of success in public health efforts. Many deaths reflected among the recent top 10 leading causes of death, were premature. A recent analysis demonstrated that approximately 250,000 deaths each year attributed to just the top five leading causes could be prevented (54).
Many of these preventable deaths might be averted through behaviors and strategies that can decrease risk and increase protection from developing these conditions. For example, the national reductions in tobacco use alone since 1964 have been attributed with increasing life expectancy by 30% (25). Continued improvements could be made in extending life expectancy, decreased YPLL as a result of the leading causes of death, and improved quality of life with greater decreases in risky behaviors such as tobacco use and binge drinking; increases in protective factors such as physical activity and improved nutrition; increased control of chronic conditions such as high blood pressure, high cholesterol, and diabetes; and decreases in the preventable transmission of infectious diseases.
CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors—United States, 2005–2013.