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April 11, 2018

US infectious disease deaths are falling—but not everywhere

Daily Briefing

    The rate of U.S. deaths from infectious diseases declined nearly 19% from 41.95 deaths per 100,000 individuals in 1980 to 34.10 deaths per 100,000 individuals in 2014—but the death rate was much higher in some counties than in others, according to a study in JAMA.

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    For the study, the researchers estimated mortality rates and trends in the United States from 1980 to 2014 for hepatitis, HIV/AIDS, diarrheal diseases, lower respiratory infections, meningitis, and tuberculosis. The researchers based the estimates on de-identified death records from the National Center for Health Statistics (NCHS) and population counts from the Human Mortality Database, NCHS, and the U.S. Census Bureau.

    Key findings

    Overall, the researchers found the mortality rate from infectious diseases decreased 18.73% from 1980 to 2014. In total, the researchers attributed 4,081,546 U.S. deaths to infectious diseases from 1980 to 2014. The researchers estimated 72,220 occurred in 1980 and 113,650 occurred in 2014.

    The researchers in 2014 attributed:

    • 78.8% of infectious disease deaths to lower respiratory infections;
    • 7.07% of infectious disease deaths to diarrheal diseases; and
    • 7.04% of infectious disease deaths to HIV/AIDs.

    Those three conditions were the three leading causes of death that year.

    The researchers found substantial variation in death rates across counties. In particular, the researchers found the "largest absolute mortality inequality among counties" for deaths attributed to lower respiratory infections. The 90th percentile had an average of 43 lower respiratory deaths per 100,000, while the 10th percentile averaged 18, according to the study. The researchers found lower respiratory infection mortality was highest in counties in Alabama, Arkansas, Georgia, Kentucky, Louisiana and Tennessee.

    The researchers found HIV/AIDs morality in 2014 concentrated predominantly in the southeastern region of the United States. According to the study, Union County, Florida, had the highest HIV/AIDs morality rate, at 64.87 per 100,000 individuals.

    In addition, the researchers said diarrheal diseases were the only cause of infectious disease mortality that increased between 2000 and 2014. The rate was 2.41 deaths per 100,000 in 2014, according to the study. The researchers noted that "many counties of high mortality extend[d] from Missouri to the northeastern region of the United States."


    Ali Mokdad, one of the study's authors and professor of global health and epidemiology at the University of Washington School of Public Health, drew attention to the overall improvement as well as the disparity among counties. "As a country we are doing much better, but certain counties are still lagging behind and are in fact getting worse," Mokdad said. He added that a number of factors, including low-income levels and limited access to quality care, can predict a community's health outcomes.  

    Separately, Emily Shuman and Preeti Malani of the University of Michigan in Ann Arbor in an accompany editorial, suggested certain demographic factors might help explain variation in lower respiratory infection mortality. "Persons with low income, homelessness, incarceration, and African American race/ethnicity have an increased risk of bacteremic pneumonia," they wrote. They continued, "A recent study of Tennessee Medicaid recipients also suggested that prescription opioid use ... was associated with increased risk of invasive pneumococcal disease" (Ross Johnson, Modern Healthcare, 3/27; Walker, MedPage Today, 3/27; Green, Healio, 3/27; Snyder, Axios, 4/5; el Bcheraorui et al., JAMA, 3/27).

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