Injuries are a common cause of death for children of all ages.7 Among children ages 1 to 4, unintentional injuries were the leading cause of death, followed by congenital anomalies, malignant neoplasms, homicide and legal intervention, and diseases of the heart.8 In 1996, all injuries, including homicides and suicides, accounted for 52 percent of deaths to children ages 5 through 14 and for 80 percent of deaths to youth ages 15 through 19.9,10
Overall, child death rates have decreased substantially over the past several decades (see Figure HC 1.2.A). In 1998, death rates per 100,000 were 35.6 for 1- through 4-year-olds, 18.5 for 5- through 9-year-olds, 23.1 for 10- through 14-year-olds, and 73.3 for 15- through 19-year-olds.
Differences by Age. The most dramatic declines in death rates occurred among children under age 15, with decreases of 67 percent among children ages 1 to 4, 62 percent among children ages 5 to 9, and 48 percent among children ages 10 through 14 since 1960 (see Figure HC 1.2.A). Most of the decline in the death rate for these groups occurred between 1960 and 1990. In contrast, death rates for youth ages 15 through 19 have decreased by only 21 percent since 1960. Moreover, unlike the fairly steady declines among the younger age groups, the death rate for this age group has had a variable pattern over the last 30 years (see Figure HC 1.2.A).
Differences by Race and Hispanic Origin. Multi-year data from the National Center for Health Statistics are used to examine the differences in the death rate of children and youth for several racial and ethnic groups across three time periods spanning 1989 through 1998 (see Table HC 1.2). For children ages 1 to 14 and youth ages 15 to 24, black children and youth have the highest death rate, followed by American Indian/Alaska Native, Hispanic, and white children and youth. Asian children and youth consistently have the lowest death rates.
The death rate for children ages 1 to 14 decreased modestly for all racial and ethnic groups except American Indian/Alaska Native children. The death rate for American Indian/ Alaska Native children dropped sharply from its high of 40 in 1994-1996 to 33 in 1998. Trends in the death rate for youth ages 15 to 24 were similar with all racial groups. Overall, black and American Indian/Alaska Native youth experienced the largest decreases for the 15- to 24-year-old age group.
Differences by Race for Adolescents. The black-white disparity among adolescents ages 15 through 19 was substantial in 1970 but had declined by 1980 to the point where black youth registered lower death rates than white youth (see Figure HC 1.2.B). This reversal was short-lived, however. Black death rates surged from 85.2 per 100,000 in 1985 to 145.0 per 100,000 by 1994, while white death rates remained fairly stable. Much of this increase in black teen deaths reflected a substantial increase in black teen male homicide rates, which are reviewed in Section HC 1.4 of this report. Recently, the difference between the white and black adolescent death rates has narrowed, as the rate for blacks declined 27 percent between 1994 and 1997.
Differences by Gender. Male child death rates are higher than female rates for all age and racial/ethnic groups, but the differences are far more pronounced for the older age groups, for whom injury-related deaths disproportionately affect males (see Table HC 1.2).11
Figure HC 1.2.A Child and youth death rates (per 100,000 population in each age group) in the United States, by age group: Selected years, 1960-1998
Source: Murphy, 1999.
Table HC 1.2 Child and youth death rates (per 100,000 population in each age group) in the United States, by age group, gender, and race and Hispanic origin: 1989-1998
|Combined Years 1989-1991||Combined Years 1992-1993||Combined Years 1994-1996||1998|
|American Indian/Alaska Nativea||37.3||45.1||29.2||38.9||47.0||30.6||40.0||45.1||34.8||33.4||38.4||28.2|
|Ages 15 to 24|
|American Indian/Alaska Nativea||142.0||208.3||71.1||129.4||184.2||71.4||127.2||188.5||63.6||115.6||166.4||64.1|
a Includes persons of Hispanic origin
b Persons of Hispanic origin may be of any race. Death figures for Hispanic persons are based on data from 44 states and the District of Columbia that reported Hispanic origin on the death certificate in 1989, 47 states and the District of Columbia in 1990, 48 states and the District of Columbia in 1991 and 1992, and 49 states and the District of Columbia in 1993-1996.
Note: Death rates reported for white and black persons are based on highly consistent information. However, persons identified as American Indian, Asian, or Hispanic origin in the data from the Census Bureau (denominator of death rates) are sometimes misreported as white or non-Hispanic on the death certificate (numerator), resulting in underestimates of about 22 percent to 30 percent for death rates of American Indians, about 12 percent for death rates of Asians, and about 7 percent for persons of Hispanic origin. (National Center for Health Statistics, Health, United States, 1993, Table 33; Sorlie, P.D., Rogot E., and Johnson, N.J. 1992. "Validity of Demographic Characteristics on the Death Certificate." Epidemiology 3 (2): 181-184.)
Sources: Murphy, 1999, Centers for Disease Control and Prevention, National Center for Health Statistics. Data Computed by the Division of Analysis from data compiled by the Division of Vital Statistics and from national population estimates for race groups. Also, data computed by Infant and Child Health Studies Branch, National Center for Health Statistics, from mortality data compiled by Division of Vital Statistics, Centers for Disease Control, National Center for Health Statistics, 1994, Health,Table 32.
Figure HC 1.2.B Youth death rates (per 100,000 population in age group) in the United States for ages 15 through 19, by race: Selected years, 1970-1998
Sources: Peters, Kochanek, & Murphy, 1998, 1996 United States Deaths; Anderson, Kochanek, & Murphy, 1997; Murphy, 1999, Table 2.
7 Injury-related deaths include deaths from motor vehicle crashes, fires and burns, drowning, suffocation, and accidents caused by firearms and other explosive materials, as well as homicides, suicides, and other external causes of death. See Fingerhut, L.A., Annest J.L., Baker, S.P., Kochanek, K.D., & McLoughlin, E. 1996. Injury Mortality among Children and Teenagers in the United States, 1993. Injury Prevention, 2: 93-94.
8 Murphy, S.L. 1999. Deaths: Final Data for 1998. National Vital Statistics Report, 48, (11). Hyattsville, MD: National Center for Health Statistics.
9 Percentages calculated by Child Trends based on data on the number of deaths from all causes and from injuries. Peters, Kochanek, & Murphy, 1998, Table 2; National Center for Injury Control and Prevention, Centers for Disease Control. 1996 United States Deaths and Rates per 100,000: All Injury, available online at http://www.cdc.gov/ncipc/osp/states/0001.htm, 10/15/98.
10 Discussion and data regarding motor vehicle crashes, the largest category of accident-related death for 15- to 19-yearolds, follows in the next section (HC 1.3).
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