13. Causes of Death
Table 13‑1: Causes of Death Summary Table
|
Cause of Death |
County Data* |
Recent Change |
U.S. Comparison |
IN Comparison |
HP 2010 |
|||||
|
yrs |
% Change |
DC |
U.S. Data* |
DC |
IN Data* |
DC |
||||
|
Positive Indicators for Marion County |
||||||||||
|
Strokes |
45 (2005) |
5 |
-26% (2000-2005) |
C |
50 (2004) |
C |
50 (2005) |
C |
12-7 50 |
|
|
Heart Disease |
192 (2005) |
5 |
-23% (2000-2005) |
C |
218 (2004) |
C |
222 (2005) |
C |
12-1 162 |
|
|
Breast Cancer |
14 (2005) |
5 |
-13% (2000-2005) |
C |
14 (2004) |
DC |
13 (2005) |
DC |
3-3 10.6a |
|
|
Accidents |
22 (2005) |
5 |
-12% (2000-2005) |
C |
37 (2004) |
C |
39 (2005) |
C |
15-13 17 |
|
|
Neutral Indicators for Marion County |
||||||||||
|
Suicide |
10 (2005) |
5 |
-9% (2000-2005) |
DC |
6 (2004) |
DC |
12 (2005) |
C |
18-1 5 |
|
|
All Cancer |
214 (2005) |
5 |
-1.4% (2000-2005) |
DC |
185 (2004) |
D |
199 (2005) |
DC |
3-1 159 |
|
|
Diabetes |
27 (2005) |
5 |
0% (2000-2005) |
DC |
24 (2004) |
D |
27 (2005) |
DC |
5-3 8 |
|
|
Motor Vehicle Accidents |
9 (2005) |
5 |
0% (2000-2005) |
DC |
15 (2004) |
C |
15 (2005) |
C |
15-15a 8 |
|
|
Negative Indicators for Marion County |
||||||||||
|
AIDS |
5 (2005) |
5 |
+67% (2000-2005) |
D |
4 (2004) |
D |
2 (2005) |
D |
13-14 1 |
|
|
Alzheimer’s |
21 (2005) |
5 |
+31% (2000-2005) |
D |
22 (2004) |
DC |
25 (2005) |
C |
NA |
|
|
Kidney Disease |
18 (2005) |
5 |
+20% (2000-2005) |
D |
14 (2004) |
D |
20 (2005) |
C |
NA |
|
|
Homicide |
13 (2005) |
5 |
+18% (2000-2005) |
D |
6 (2004) |
D |
6 (2005) |
D |
15-32 2.8 |
|
* All data are age-adjusted death rates per 100,000 persons to the year 2000 U.S. standard population. Deaths among Marion County Residents, per death certificate data 2005(DR0483-T37). Causes of death are classified using National Center for Health Statistics categories using the International Classification of Diseases, version 10 (ICD-10) coding.
a Healthy People 2010 objective 3-3 is 21.3 breast cancer deaths per 100,000 females. We approximate the overall (both gender) rate implied by this objective by dividing it in half.
Table notes: County data: Is for most recent year available. Recent Change: Percent change of most recent measurement from a measurement the noted number of years prior. Changes of more than 5 percent in either direction are denoted by thumbs up or thumbs down symbolsthumbs up or thumbs down. Neutral thumbs indicate no change, even though no change may be a negative outcome; U.S. or IN population data: Is for most recent year available; U.S. (or IN) Comparison: Comparison of most recent data using thumbs up or thumbs down symbols to denote differences that are statistically significant or deemed to be noteworthy from the analysts’ professional perspective. Note: When there is no public health implication associated with a measure, directional arrows replace thumb icons to indicate the direction of change or the relationship of the Marion County measure (higher/lower/not different) to the U.S./IN measure.
Leading Causes of Death Within Age Groups
The leading causes of death[517] during the first year of life are complications of pregnancy, birth defects, and prematurity. Infant mortality is discussed in more detail in the Infant Mortality section of Chapter 8, Children’s Health. Among youth, there were 45 or fewer deaths in each of the past six years, with accidents causing one out of every four deaths (see the Child Mortality section within Chapter 8, Children’s Health). Among young adults, homicide and accidents (unintentional injuries) are the leading causes of death. After age 45, chronic diseases assume primacy and heart disease, cancer, chronic obstructive pulmonary disease (COPD) and stroke are the leading causes of death. These four causes also are the leading causes of death overall. Heart disease is the leading cause of death both for all Americans and for Marion County residents. Nationally, stroke is the third leading cause of death and in Marion County it is the fourth leading cause.
General Mortality
The total, age-adjusted mortality rate for Marion County in 2005 was 864 deaths per 100,000 persons, about one percent higher than the State’s rate, and 8 percent higher than the national rate. One quarter of this 8 percent can be attributed to excess lung cancer deaths, and another quarter to excess Chronic Obstructive Pulmonary Disease (COPD). Over 90 percent of COPD deaths are attributable to smoking, as are 90 percent of female lung cancer deaths and 79 percent of male lung cancer deaths.[518] Without the lung cancer and COPD deaths attributable to smoking, Marion County’s total mortality rate might have been 28 percent lower,[519] giving Indianapolis the lowest mortality rate of any large city in the U.S.
The four most common causes of death among Marion County residents between 2002 and 2005 were cancer (214.0 deaths per 100,000 persons), heart disease (192.0), chronic obstructive pulmonary disease (COPD) (59.0), and stroke (45.0) (Table 13‑2). Stroke, diabetes and homicide consistently ranked higher as causes of death for Blacks than for Whites over the four-year period, while COPD and dementia[520] ranked higher for Whites[521] than for Blacks (Table 13‑3). The death rate for males (1040.7) in Marion County for 2005 exceeded that for females (736.0) (Table 13‑4). Among races and ethnicities, Blacks had the highest death rate (1,099.0), followed by Whites (813.6), Other Races (551.5) and Hispanics (279.9).
Table 13‑2: Selected Age-Adjusted* Rates of Death per 100,000 Persons, Marion County, Indiana, and U.S.
|
Cause of Death |
Marion County |
Indiana 2005 |
Milwaukee County WI 2005 |
Davidson County TN 2004 |
U.S. 2004^
|
||
|
2000 |
2004 |
2005 |
|||||
|
Cancer |
217.4 |
205.2 |
214.4 |
199.1 |
200.0 |
197.4 |
184.6 |
|
Heart Disease |
247.8 |
206.9 |
191.5 |
222.0 |
209.1 |
233.5 |
217.5 |
|
COPD |
57.5 |
57.5 |
59.1 |
54.0 |
39.6 |
46.9 |
41.8 |
|
Strokes |
61.1 |
47.6 |
45.1 |
50.2 |
43.5 |
53.7 |
50.0 |
|
Unspecified Dementia |
19.8 |
28.0 |
29.3 |
NA |
NA |
NA |
NA |
|
Diabetes |
27.2 |
25.2 |
26.8 |
26.7 |
22.7 |
31.5 |
24.4 |
|
Accidents |
25.3 |
27.6 |
21.9 |
38.7 |
46.8 |
51.3 |
36.6 |
|
Motor Vehicle Accidents |
9.2 |
8.9 |
9.0 |
15.2 |
7.8 |
18.3 |
14.8 |
|
Alzheimer’s |
16.0 |
17.2 |
20.5 |
24.7 |
18.3 |
25.1 |
21.7 |
|
Influenza & Pneumonia |
17.2 |
15.9 |
19.2 |
20.1 |
20.6 |
20.6 |
20.4 |
|
Kidney Disease |
14.5 |
20.1 |
17.7 |
19.6 |
17.0 |
12.6 |
14.3 |
|
Homicide |
11.3 |
11.6 |
12.8 |
5.9 |
15.7 |
9.5 |
5.6 |
|
Suicide |
11.0 |
11.8 |
10.1 |
11.7 |
9.6 |
12.1 |
10.7 |
|
AIDS |
3.1 |
4.5 |
5.0 |
1.6 |
3.2 |
13.6 |
4.4 |
|
Tuberculosis |
0.6 |
0.1 |
0.5 |
0.2 |
NA |
0.7 |
0.2 |
|
Overall |
931.4 |
873.0 |
864.0 |
857.9 |
854.3 |
883.7 |
801.1 |
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data. NA: Not available.
Source: Marion County Death Certificates (DR0483-T37); IN: Indiana Mortality Report 2005, ISDH;[522] U.S.: CDC, National Center for Health Statistics;[523] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[524]TN: HIT (Health Information Tennessee), Tennessee Dept. of Health.[525]
Table 13‑3: Rank of Ten Leading Causes of Death, Plus Homicide, Suicide, and AIDS Deaths by Race: Marion County, 2002-2005
|
Cause of Death |
2005 |
2004 |
2003 |
2002 |
||||
|
White5 |
Black5 |
White |
Black |
White |
Black |
White |
Black |
|
|
Heart Disease |
1 |
2 |
1 |
1 |
1 |
1 |
1 |
2 |
|
Cancer |
2 |
1 |
2 |
2 |
2 |
2 |
2 |
1 |
|
COPD |
3 |
5 |
3 |
6 |
3 |
5 |
3 |
8 |
|
Stroke |
4 |
3 |
4 |
3 |
4 |
3 |
4 |
3 |
|
Unspecified Dementia |
5 |
8 |
5 |
10 |
5 |
8 |
6 |
13 |
|
Accidents |
6 |
9 |
6 |
7 |
7 |
9 |
7 |
6 |
|
Alzheimer’s |
7 |
10 |
8 (Tie) |
13 |
10 |
11 |
10 |
>11 |
|
Diabetes |
8 |
4 |
7 |
4 (Tie) |
6 |
4 |
9 |
5 |
|
Pneumonia & Influenza |
9 |
>11 |
10 |
15 |
11 |
14 |
8 |
12 |
|
Kidney Disease |
10 |
7 |
8 (Tie) |
8 |
9 |
7 |
11 |
7 |
|
Homicide |
21 |
6 |
22 |
4 (Tie) |
20 |
6 |
21 |
4 |
|
Suicide |
14 |
16 |
11 |
21 |
13 |
18 |
12 |
18 |
|
AIDS |
24 |
15 |
24 |
14 |
26 |
15 |
23 |
16 |
Source: Marion County Death Certificates (DR0483-T36).
Table 13‑4: Marion County All Causes Death Rates by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
80.1 |
110.2 |
173.5 |
742.9 |
4865.7 |
864.2 |
|
Males |
84.7 |
185.0 |
223.7 |
919.5 |
5743.6 |
1040.7 |
|
Females |
75.2 |
35.0 |
123.5 |
583.0 |
4341.0 |
736.0 |
|
Whites |
58.5 |
72.7 |
152.2 |
682.3 |
4699.9 |
813.6 |
|
Blacks |
116.1 |
170.9 |
262.1 |
1039.2 |
5866.2 |
1099.0 |
|
Hispanics |
106.1 |
145.1 |
70.5 |
311.3 |
1162.0 |
279.9 |
|
Other Races |
52.4 |
132.3 |
102.2 |
233.3 |
3478.3 |
551.5 |
|
White Males |
62.0 |
111.6 |
191.5 |
821.3 |
5535.3 |
967.9 |
|
White Females |
54.8 |
34.0 |
113.0 |
551.9 |
4197.5 |
703.2 |
|
Black Males |
121.8 |
307.5 |
375.3 |
1393.7 |
7089.9 |
1386.3 |
|
Black Females |
110.2 |
39.2 |
167.2 |
755.3 |
5152.9 |
897.9 |
|
Hispanic Males |
114.7 |
251.3 |
83.7 |
515.4 |
1493.3 |
387.6 |
|
Hispanic Females |
97.1 |
0 |
47.4 |
60.5 |
887.7 |
160.6 |
|
Other Males |
53.3 |
142.8 |
131.3 |
325.3 |
3807.8 |
623.9 |
|
Other Females |
51.6 |
123.2 |
72.1 |
158.2 |
3610.3 |
541.1 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
Source: Marion County Death Data (DR0483-T39.3).
Heart Disease
Heart disease is the leading cause of death in the United States, representing 22 percent of the country’s total mortality. Deaths due to heart disease have been decreasing in recent years, both nationally and in Marion County. The Marion County death rate for heart disease declined by 23 percent between 2000 and 2005 (Table 13‑2). The Marion County heart disease death rates for 2004 through 2005 also compared favorably with those for Indiana, the U.S., and comparison counties in Wisconsin and Tennessee.
Marion County heart disease death rates in 2005 were generally higher for men than for women, and higher for Blacks than for Whites (Table 13‑5). Gender differences were especially pronounced in the 25 to 44 and 45 to 64 year old age groups, where male to female rate ratios were over 2 to 1. The Marion County heart disease mortality rate of 192 per 100,000 persons has significantly decreased since 2000 when the rate was 248 per 100,000. It is now approaching the revised Healthy People 2010 objective 12-1. of no more than 162 heart disease deaths per 100,000.[526]
Preventable risk factors for heart disease and stroke have been established by several national and international cohort studies and include, high serum total and LDL cholesterol levels, hypertension, obesity, and diabetes.[527] Non-modifiable risk factors include family history of stroke or heart disease, as well as gender, race and age. High-risk behaviors also amenable to change include reduced smoking and physical inactivity, and high fat/ low fiber dietary intake, avoiding weight gain in adulthood, use of a low-dose aspirin by adults and appropriate stress reduction to maintain cardiovascular health.[528]
Secondary prevention methods for persons with clinical changes in blood pressure, cholesterol and glucose or insulin function include regular clinical monitoring of blood pressure, serum cholesterol components, and blood glucose levels, and adherence to medication regimens for these conditions. Significant end-organ changes, such as altered cardiac performance, can be tested by stress ECG monitoring and atherosclerotic vessel changes can be indicated in angiograms or carotid artery sonograms. These tests may prompt invasive procedures (bypass surgery; stent placement or angioplasty for example) which improve quality of life for heart disease patients, but are not major factors in reducing mortality risk.[529]
Table 13‑5: Marion County Heart Disease Death Rates by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
1.8 |
3.7 |
21.1 |
148.6 |
1197.3 |
191.5 |
|
Males |
0.9 |
3.7 |
30.1 |
208.9 |
1393.6 |
232.2 |
|
Females |
2.7 |
3.7 |
12.1 |
93.7 |
1078.5 |
161.8 |
|
Whites^ |
1.5 |
4.6 |
20.9 |
141.7 |
1177.2 |
187.5 |
|
Blacks^ |
3.1 |
2.8 |
25.8 |
188.8 |
1312.7 |
216.6 |
|
White Males |
0 |
6.2 |
28.5 |
198.3 |
1412.6 |
231.9 |
|
White Females |
3.1 |
3.1 |
13.3 |
88.6 |
1031.4 |
155.1 |
|
Black Males |
3.1 |
0 |
41.9 |
270.8 |
1391.4 |
249.2 |
|
Black Females |
3.2 |
5.6 |
12.3 |
123.0 |
1265.2 |
192.3 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 6 Hispanic, and 14 Other Race, Non-Hispanic Heart Disease deaths in 2005. Heart Disease deaths per 100,000 persons among the Marion County Hispanic population are 50.7 among men, 22.5 among women, and 39.1 overall.
Source: Marion County Death Data (DR0483-T39.1)
Cancer
Death rates for all cancers, breast cancer, and prostate cancer fell in Marion County between 2000 and 2005, while rates of death from lung cancer and colorectal cancer increased (Table 13‑6). The Marion County death rates for all cancers (214.4 per 100,000), lung cancer (71.0), and breast cancer (13.7) in 2005 exceeded the death rates for those causes in Indiana, the U.S., and the two comparison counties for the closest years available. However, for the most recent comparison year (2004), Indianapolis had the third lowest breast cancer mortality rate among 54 largest U.S. cities.[530] In 2005, the Marion County death rate for prostate cancer was lower than the Healthy People 2010 objective. The breast and cervical rates were somewhat above the Healthy People 2010 objectives, while lung, colorectal, and overall cancer mortality rates were far above the objectives.[531]
Deaths from lung cancer are especially common in Marion County. The age-adjusted rate of 71 deaths per 100,000 residents in 2005 was 34 percent higher than the 2004 national rate. Compared to the 54 largest U.S. cities, for the most recent comparison year (2004), Indianapolis had the 6th highest rate of lung cancer mortality.[532]
Deaths rates for all cancers in Marion County for 2005 were higher for males than for females and higher among Blacks than among Whites (Table 13‑7). After age 65 years, the cancer death rate for White males was over two-thirds higher than that for White Females. Among Blacks over 65 years of age, the cancer death rate was more than twice as high for males than for females.
Table 13‑6: Selected Age-Adjusted* Rates of Cancer Deaths per 100,000 Persons for Marion County, Indiana, Comparable Counties, and Healthy People 2010 Objectives
|
Cause |
Marion County 2000 |
Marion County 2005 |
Indiana 2005 |
U.S. 2004^ |
Milwaukee County WI 2005 |
Davidson County TN 2004 |
Healthy People 2010 Objective |
|
Lung |
67.7 |
71.0 |
63.0 |
52.9 |
54.4 |
66.0 |
43.3 |
|
Colorectal |
18.5 |
19.2 |
19.4 |
17.9 |
16.5 |
17.8 |
13.7 |
|
Breast |
16.2 |
13.7 |
12.9 |
13.6 |
13.1 |
12.9 |
10.6a |
|
Prostate |
12.1 |
10.1 |
8.7 |
9.7 |
9.8 |
9.2 |
14.1a |
|
Cervical |
1.1 |
1.1 |
1.4 |
1.3 |
1.4 |
1.5 |
1.0a |
|
All Cancer |
217.4 |
214.4 |
199.1 |
184.6 |
200.0 |
197.4 |
158.6
|
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data.
a Healthy People 2010 objective 3-3 and 3-4 are 21.3 breast and 2.0 cervical cancer deaths per 100,000 females. Objective 3-7 is 28.2 prostate cancer deaths per 100,000 males. We approximate the overall (both gender) rates implied by these objectives by dividing them in half.
Source: Marion County Death Data (DR0483-T38); IN: Indiana Mortality Report 2005, ISDH;[533] U.S.: CDC, National Center for Health Statistics;[534] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[535]TN: HIT (Health Information Tennessee), Tennessee Dept. of Health;[536] Healthy People 2010 Objective: Healthy People 2010, U.S. Department of Health and Human Services. [537]
Table 13‑7: Marion County All Cancers Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
2.5 |
5.5 |
28.0 |
245.8 |
1187.8 |
214.3 |
|
Males |
3.0 |
9.2 |
17.6 |
267.8 |
1628.1 |
272.4 |
|
Females |
2.0 |
1.8 |
38.3 |
226.8 |
925.2 |
179.4 |
|
Whites^ |
2.4 |
6.2 |
26.4 |
232.3 |
1140.4 |
205.0 |
|
Blacks^ |
1.7 |
5.7 |
40.0 |
328.0 |
1511.8 |
277.0 |
|
White Males |
1.5 |
9.3 |
15.4 |
250.5 |
1526.7 |
254.8 |
|
White Females |
3.4 |
3.1 |
37.5 |
216.3 |
912.6 |
175.7 |
|
Black Males |
3.3 |
11.6 |
28.4 |
379.5 |
2254.9 |
380.1 |
|
Black Females |
0 |
0 |
49.6 |
287.1 |
1074.9 |
214.4 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 4 Hispanic, and 5 Other Race, Non-Hispanic deaths from All Cancers in 2005. Deaths from All Cancers per 100,000 persons among the Marion County Hispanic population are 18.7 among men, 13.4 among women, and 16.5 overall.
Source: Marion County Death Data (DR0483-T39.4)
Healthy dietary habits, including fiber and anti-oxidant rich fruits, vegetables, and low animal-fat intake, as well as physical activity have been established as good primary prevention strategies to reduce colon and breast cancer incidence.[538] As cigarette smoking is a direct risk factor for over 80 percent of lung cancer, primary prevention requires reduced smoking initiation among youth, early and successful cessation by current smokers, and reduced exposure to any second-hand smoke (SHS) among non-smokers.[539] Smoke-free workplace ordinances have been increasingly accepted as a major public health policy to reduce the public SHS exposure, while social marketing strategies and increased tobacco taxation have been successful in reducing uptake and promoting cessation in youth.
Similarly appropriate clinical screening tests for breast (self- and clinical examinations; mammography), colon (colonoscopy; FOBT), cervical (Pap tests) and prostate (PSA) cancer provide secondary prevention via early detection and intervention in the disease. There is a greater survival rate and lower costs of morbidity and lost productivity for any of these cancers, which is treated while still localized and in its earliest stages.[540]
Stroke
Like heart disease death rates, stroke death rates nationally have declined steadily over many years. The decline has occurred mainly due to improved detection and treatment of high blood pressure.[541] Stroke deaths share several risk factors with heart disease, including uncontrolled high blood pressure, cigarette smoking, high cholesterol, and obesity.[542] Prevention strategies include maintaining healthy weight and physical activity levels. Secondary prevention includes early detection and monitoring of persons with elevated blood pressure and adherence to anti hypertension medications by treated individuals
The overall Marion County stroke death rate decreased by 26 percent from 2000 to 2005 (Figure 13‑1). The 2005 Marion County stroke death rate was lower than the 2005 stroke death rate for Indiana, the U.S., and that of Nashville, Tennessee (Davidson County). The 2005 Marion County stroke death rate was slightly higher than the stroke death rate for Milwaukee County in 2005. The 2004 and 2005 stroke death rates for Marion County (45 deaths per 100,000 persons) have met and surpassed the Healthy People 2010 objective 12-7 of 50 deaths per 100,000 persons.[543]
Figure 13‑1: Age-Adjusted* Rates of Stroke Deaths per 100,000 Persons for Marion County and Comparison Populations
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data.
Source: Marion County Death Data (DR0483-T37); IN: Indiana Mortality Report 2005, ISDH;[544] U.S.: CDC, National Center for Health Statistics;[545] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[546]TN: HIT (Health Information Tennessee), Tennessee Dept. of Health.[547]
Marion County stroke death rates for all ages in 2005 were only slightly higher for females than for males, but were 44 percent higher for Blacks[548] than for Whites (Table 13‑8). In the 25 to 44 and 45 to 64 year old age groups, the Black stroke death rate was over three times the rate for Whites. Stroke death rates increased significantly for all groups shown in the table after 65 years of age. Comparing race-sex combinations within that age group, Black males had the highest stroke death rate, and White males had the lowest stroke death rate.
Table 13‑8: Marion County Stroke Deaths per 100,000 Persons by Age, Race, and Sex, 2005