NEW JERSEY HEALTH STATISTICS, 2004
Since 1996, New Jersey’s age-adjusted death rate has been below that of the U.S. as a whole. In 2004, the U.S. age-adjusted death rate was 800.8 per 100,000 population, an all-time low. From 1994 to 2004, New Jersey’s age-adjusted death rate declined 16.8%, while the U.S. rate declined 12.3% (Table DT1 and Figure DT1).
County age-adjusted death rates in 2004 ranged from a low of 624.0 deaths per 100,000 residents in Hunterdon County to a high of 922.7 in Cumberland County (Table DC1 and Figure DC1).
On average there were 195 deaths of New Jersey residents each day in 2004. Death rates were highest in winter and lowest in summer. More deaths occurred on Saturdays than on any other day (202, on average) and Thursdays had the fewest deaths (191, on average) (Table DS1).
CHANGES IN THE DEATH CERTIFICATE
A new death certificate format was introduced in 2004. Major changes to the certificate include the ability to choose more than one race and Hispanic ethnicity for the decedent, additional place of death and disposition categories, expansion of the pregnancy checkbox items, and the addition of checkboxes for whether the decedent had diabetes and if smoking contributed to death.Two or more races were selected on only 0.3% of certificates, so the affect on trend data by race is negligible. The addition of hospice facility as a place of death (3.0%) and donation and removal from state as dispositions (2.5%), on the other hand, had a small but noticeable affect on trends as those categories were previously collapsed into others. Responses to the pregnancy checkbox question affect the underlying cause of death; therefore the expansion of the checkbox items to include deaths up to one year after the end of a pregnancy resulted in a sharp increase in maternal deaths.
Death rates decreased for all age groups over the past decade. For residents under the age of 15 and between 25 and 64 years, death rates declined by one-fifth or more. For those aged 65 years and over, rates decreased by one-tenth. The 15-24 age group experienced the smallest decline: 5% (Table DT2 and Figures DT2-8).
While 30% of male deaths occurred before age 65, only 18% of female deaths did (Table DS2a and Figure DS2a). For every age group, death rates were higher for males than for females. The greatest difference (163%) was in the 15-24 year age group: 95.9 deaths per 100,000 population for males versus 36.4 for females. White and Hispanic males had higher age-specific death rates than females for every age group, but the same was not true for Blacks and Asians/Pacific Islanders. Black females aged 5-14 had slightly higher death rates than their male counterparts. Asian and Pacific Islander females under age 5 had higher rates than males under age 5 years (Table DS3).
Of the 16 counties for which rates could be calculated, Morris County had the lowest death rate (28.6 per 100,000 population) and Cumberland had the highest (92.3) for those aged 15 years and under. Among the 15 counties for which rates could be calculated, Morris had the lowest death rate (42.4) and Essex had the highest (118.9) among residents aged 15-24 years. Death rates for residents aged 25-44 years ranged from 80.4 in Morris County to 228.2 in Essex County. The lowest death rate for residents 45-64 years old was in Hunterdon County (310.9) and the highest was in Cumberland County (889.7). Death rates for residents aged 65-84 years ranged from 2,410.9 in Hunterdon County to 4,290.8 in Salem County. Essex County had the lowest death rate among those aged 85 and over (11,584.8) and Gloucester County had the highest (16,803.3) (Table DC2 and Figures DC2-5).
Race/ethnicity and nativity
There were 57,574 deaths (81% of all deaths) among Whites, 8,955 (13%) among Blacks, 3,237 (5%) among Hispanics, and 1,160 (1.6%) among Asians/Pacific Islanders in 2004. Among Hispanics, 1,343 (41%) were of Puerto Rican ancestry, 585 (18%) were Cuban, and 496 (15%) were South American. Among Asians and Pacific Islanders, 364 (31%) were of Indian ancestry, 235 (20%) were Chinese, 226 (19%) were Filipino, and 172 (15%) were Korean (Tables DS4 and DS5).
In 2004, 84% of decedents were born in the United States, 1.8% were born in Puerto Rico, and 12% were born elsewhere. About 90% of Whites and Blacks were native-born, as compared with only 9% of Asians and Pacific Islanders. Sixteen percent of Hispanic decedents were native-born, 32% were born in Puerto Rico, and 47% were foreign-born (Table DS6 and Figure DS3).
From 1994 to 2004, age-adjusted death rates declined among all major race/ethnicity groups in New Jersey. The changes were greatest among Blacks and Hispanics. The rate declined by 22% for Blacks and 21% for Hispanics, but only 14% for Whites and 5% for Asians and Pacific Islanders. In 2004, age-adjusted death rates were 758.0 for Whites, 997.2 for Blacks, 450.4 for Hispanics, and 356.6 for Asians and Pacific Islanders per 100,000 population (Table DT3 and Figure DT10).Age-adjusted death rates for Whites ranged from a low of 634.0 in Hunterdon County to a high of 932.2 in Cumberland County. Among the 18 counties with a sufficient number of deaths to calculate a reliable rate, age-adjusted death rates among Blacks ranged from 747.3 in Bergen to 1,418.0 in Cape May. Fifteen counties had reliable age-adjusted death rates for Hispanics and rates ranged from 278.5 in Somerset to 607.3 in Camden. In the 14 counties with reliable figures, age-adjusted death rates for Asians and Pacific Islanders ranged from 260.6 in Somerset to 444.8 in Ocean County (Table DC3).
Age-adjusted death rates among males declined 21% from 1994 to 2004, while rates among females only decreased 13%. However, in 2004, the rate for males was still 38% higher than the rate for females: 893.0 versus 647.4, respectively (Table DT4 and Figure DT11). The sex-difference varied slightly by race and ethnicity. The difference was greatest among Hispanics where age-adjusted death rates were 541.6 among males and 376.3 among females, a 44% difference. The difference was 43% for Blacks (1,210.4 vs. 844.6), 38% for Whites (898.5 vs. 652.2), and 37% for Asians and Pacific Islanders (418.9 vs. 305.6) (Table DS2 and Figure DS2).
Between 2000 and 2004, life expectancy at birth increased 1.4 years to 79.0 years. While it increased 1.0 years for Whites (to 79.2) and 2.0 years for Blacks (to 73.3), it increased 2.7 years for Hispanics (to 84.6) and 3.5 years for Asians/Pacific Islanders (to 89.1). Some of the increase among Hispanics and Asians/Pacific Islanders may be due to placement of the ethnicity item before the race item and the ability to select more than one race on the death certificate, respectively. Therefore, Hispanics are better identified and persons of one or more races are not included in the single race groups for 2004. Life expectancy for males rose 1.6 years to 76.4 and for females rose 1.1 years to 81.3 (Table DT5 and Figure DT12). Among all race/ethnicity/sex groups, life expectancy ranged from 69.8 years for Black males to 91.8 years for Asian/Pacific Islander females (Table DS7 and Figure DS4).
PLACE OF DEATHBetween 1994 and 2004, the number of deaths to inpatients declined 25% and deaths “on arrival” (DOA) decreased 44%. Meanwhile, deaths in nursing homes increased 69%. The numbers of deaths occurring at home or as outpatients or in a hospital emergency department were about the same in 2004 as in 1994 (Table DT6). A new category, hospice facility, was added to the death certificate in 2004. In prior years, hospice deaths were included in the inpatient or “other” counts. In 2004, 41% of deaths occurred to inpatients, 23% occurred at the decedent’s residence, 19% occurred in nursing homes, 6% occurred as outpatients or in a hospital E.D., 3% occurred at a hospice facility, and 1% were DOA. The cause of death affects place of death in some cases. Notably, 80% of septicemia deaths occurred to inpatients, 36% of cancer deaths occurred at home, and 61% of deaths due to Alzheimer’s disease occurred in nursing homes. Among deaths due to unintentional injury, 15% occurred as outpatients or in an E.D., 5% were DOA, and 26% occurred in some other place such as the location of the accident (Table DS8).
DISPOSITION OF DECEDENTS
The proportion of decedents who were buried decreased 13% between 1994 and 2004, while the proportion cremated increased 46% and the share entombed increased 41%. Two categories were added to the death certificate in 2004: removal from state and donation. In prior years, those removed from the state were included in the respective counts of burial, cremation, and entombment and donations were included in “other.” In 2004, 43,065 (62%) decedents were buried, 18,488 (27%) were cremated, 5,509 (8%) were entombed, 1,661 (2%) were removed from the state, and 152 (0.2%) were donated (Table DT7). Disposition varied widely by race/ethnicity. Over two-thirds of Blacks (77%), Koreans (72%), persons of two or more races (69%), Puerto Ricans (75%), Dominicans (72%), and Mexicans (77%) were buried. More than two-thirds of Indians (74%) were cremated. Twenty percent of Cubans and 15% of Filipinos were entombed (Table DS9 and Figure DS5).
LEADING CAUSES OF DEATH
The ten leading causes of death in 2004 were the same as in 1998-2003 with some changes in rank within the top ten: heart disease (20,564 deaths), cancer (17,215), stroke (3,784), chronic lower respiratory diseases (CLRD) (3,034), diabetes (2,599), unintentional injuries (2,329), septicemia (1,902), Alzheimer’s disease (1,713), kidney diseases (1,627), and influenza and pneumonia (1,588) (Tables DT8 and DS10 and Figure DS6). On an average day, there were 195 deaths: 56 due to heart disease, 47 cancer, 10 stroke, 8 CLRD, 7 diabetes, 6 unintentional injuries, 5 septicemia, 5 Alzheimer’s disease, 4 kidney disease, 4 influenza/pneumonia, and 41 due to other causes (Figure DS7).The statewide age-adjusted death rate due to heart disease was 213.0 in 2004. County rates ranged from 168.9 in Hunterdon to 271.8 in Cumberland. For cancer, the statewide rate was 184.5 and county rates ranged from 133.7 in Hunterdon to 213.8 in Salem. The age-adjusted stroke death rate for New Jersey was 39.2. Bergen County’s rate of 33.6 was the lowest and Burlington’s rate of 48.5 was the highest. The statewide age-adjusted CLRD death rate was 32.1 and rates ranged from 24.0 in Bergen to 60.4 in Sussex County. The statewide age-adjusted death rate due to diabetes was 27.6. County rates ranged from 20.7 in Bergen to 37.7 in Sussex (Table DC4).
Infant deaths (deaths under 1 year of age) are reported and discussed in a separate chapter. The leading causes of death of residents aged 1-4 years in 2004 were the same as in 2003: unintentional injuries (22 deaths) and congenital anomalies (12 deaths). These two causes accounted for one-third of deaths in the age group (Table DT9).
Among residents 5-14 years old, the leading causes of death remained unintentional injuries (37 deaths) and cancer (21 deaths). Over 40% of the deaths in this age group were due to those two causes. More than 60% of the deaths due to unintentional injuries were motor vehicle-related (Table DT10).
In 2004, the leading causes of death among residents aged 15-24 years were unintentional injuries (282 deaths), homicide (130), suicide (78), cancer (57), and heart disease (26) (Table DS10). More than half of the deaths due to unintentional injury were motor-vehicle related. While death rates for the other four leading causes displayed no clear trend from 1994-2004, the suicide rate among 15-24 year olds had been declining fairly steadily from 1995 through 2002 before taking an upturn in 2003 that continued in 2004 (Table DT11 and Figure DT14).
Among residents aged 25-44 years, the leading causes of death were unintentional injuries (638 deaths), cancer (510), heart disease (352), HIV disease (304), and suicide (228) (Table DS10). Forty-two percent of the deaths due to unintentional injuries were drug overdoses and 39% were motor vehicle-related (Table DS32). While 2004 death rates for unintentional injuries, cancer, and heart disease were all substantially lower than they were in 1994, the death rate due to HIV disease declined steadily until 2004 and was 83% lower than the rate in 1994, when it was the leading cause of death in the age group (Table DT12 and Figure DT15).
Cancer (4,335 deaths), heart disease (2,415), unintentional injuries (521), diabetes (498), and stroke (415) were the leading causes of death for residents aged 45-64 years in 2004 (Table DS10). While the unintentional injuries and diabetes death rates showed no clear trend from 1994-2004, the rates for cancer, heart disease, and stroke all declined steadily and were each 25-40% lower in 2004 than in 1994 (Table DT13 and Figure DT16).
In 2004, cancer remained the leading cause of death of residents 65-84 years old (9,505 deaths). Other leading causes of death for this age group were heart disease (9,416), CLRD (1,814), stroke (1,749), and diabetes (1,414) in 2004. Among those aged 85 years and over, the leading causes were heart disease (8,322 deaths), cancer (2,770), stroke (1,526), and Alzheimer’s disease (1,156) (Table DS10). Among residents aged 65 and over, there was a general downward trend in death rates due to heart disease, cancer, and stroke from 1994 to 2004, while there was an increase in the death rate due to diabetes among those 65 and over and no clear trend in the death rate due to CLRD. However, there was a 141% increase in the death rate due to Alzheimer’s disease from 1994-2004. The increase in the number and rate of Alzheimer’s deaths among those aged 65 and over has been fast and steady and has been attributed to improvements in diagnosis and awareness of the condition within the medical community, as well as a possible understatement of the comparability ratio used to adjust pre-1999 data coded under ICD-9 (Table DT14 and Figure DT17)
Leading causes of death varied by race and ethnicity. The ten leading causes of death for Whites were the same as for the population as a whole, which is to be expected since 81% of decedents were White. The ranking of the seventh to tenth leading causes was different, however. Among Blacks, the three leading causes of death were the same as for the population as a whole. The fifth leading cause of death among Blacks was HIV disease (12th overall) and homicide was the ninth leading cause (18th overall). While Alzheimer’s disease was the tenth leading cause in the overall population, it was fourteenth among Blacks. For all leading causes of death except CLRD and Alzheimer’s disease, age-adjusted death rates for Blacks were higher than for Whites. Among Hispanics, the top two causes of death were the same as for the population as a whole, unintentional injuries were the third leading cause of death (6th overall), certain conditions originating in the perinatal period was eighth (20th overall), and HIV disease was ninth (12th overall). For all of the ten leading causes of death except diabetes, age-adjusted death rates for Hispanics were lower than for Whites. Among Asians and Pacific Islanders, there were more deaths due to cancer than to heart disease. Suicide was the tenth leading cause of death among Asians and Pacific Islanders (13th overall). While Alzheimer’s disease was the eighth leading cause of death in the overall population, it was eighteenth among Asians and Pacific Islanders. For all leading causes of death in the total population, age-adjusted death rates for Asians and Pacific Islanders were lower than for Whites (Table DS11 and Figure DS8).
The ten leading causes of death also varied somewhat by sex. Among males, unintentional injury was tied with stroke as the third leading cause of death while unintentional injury was ninth among females. Suicide was the tenth leading cause of death among males, while Alzheimer’s disease was eleventh. Alzheimer’s disease was the sixth leading cause of death among females while suicide was twentieth. Age-adjusted death rates for males were higher than for females for all leading causes except Alzheimer’s disease. For unintentional injuries, the rates for males was more than double the rates for females and for suicide, it was 4.6 times the rate among females (Table DS12 and Figure DS9).
In 2004, the leading types of cancer deaths were lung (4,486 deaths), colorectal (1,785), breast (1,404), pancreatic (1,050), and prostate (840). These five sites accounted for over half of the cancer deaths in 2004. Age-adjusted death rates for all cancer sites decreased from 1994 to 2004 with the exception of cancer of the liver and intrahepatic bile ducts. Large declines were seen for cancer of the prostate (40%), larynx (35%), stomach (33%), and colon, rectum, and anus (32%). The total age-adjusted cancer death rate in 2004 was down 20% from the 1994 rate (Table DS24 and Figure DS10).
The statewide age-adjusted death rate for lung cancer was 48.5 per 100,000 population. County rates ranged from 33.1 in Hunterdon to 74.8 in Salem. For colorectal cancer, the statewide rate was 18.9 and county rates ranged from 16.2 in Atlantic to 24.4 in Warren among the 19 counties with reliable rates. The age-adjusted female breast cancer death rate for New Jersey was 26.0. Hudson County’s rate of 22.0 was the lowest and Gloucester’s rate of 35.0 was the highest among the 17 counties with enough deaths to calculate reliable rates. The statewide age-adjusted pancreatic cancer death rate was 11.2 and rates ranged from 8.3 in Hudson to 17.9 in Warren County among the 16 counties with sufficient data. For prostate cancer, the statewide rate was 23.5 and county rates ranged from 18.9 in Burlington County to 34.3 in Essex County, of counties with sufficient data (Table DC8).
More than half of deaths due to cancer occurred between the ages of 65 and 84 years (9,505 deaths). However, for all cancer sites, death rates were highest among those aged 85 years and over (Table DS25). For all cancer sites, age-adjusted death rates for males were higher than rates for females, with the exception of sex-specific sites. However, in the 25-44 year age group, the age-specific overall cancer death rate was higher for females than for males due primarily to breast and cervical cancer deaths. The total age-adjusted cancer death rate was 34% higher for males than for females and the age-adjusted death rate due to lung cancer was 51% higher for males than for females. Age-adjusted death rates for males were more than double the rates for females for cancers of the lip, oral cavity, and pharynx; esophagus; stomach; liver and intrahepatic bile ducts; larynx; skin; kidney and renal pelvis; and bladder (Tables DS26 and DS27 and Figure DS11).
Among males, the three leading types of cancer deaths were lung, colorectal, and prostate. However, among Black and Hispanic males, prostate cancer outranked colorectal and among Asian and Pacific Islander males, stomach cancer was ranked third. Among females, the three leading types of cancer deaths were lung, breast, and colorectal. However, among Hispanic and Asian/Pacific Islander females, breast cancer was ranked first and lung ranked second and among Asian and Pacific Islander women, cancer of the liver and intrahepatic bile ducts was ranked third (Tables DS26 – DS31).
EXTERNAL CAUSES OF DEATH
In 2004, 2,329 New Jersey residents died as a result of unintentional injuries. One-third (771) were motor vehicle-related, one-fifth (498) were drug poisonings, and 359 (15%) were falls. Among those aged 35-54 years, drug poisoning was the leading cause of unintentional injury death and among those aged 65 and over, falls were the leading cause (Table DS32). The age-adjusted death rate due to unintentional injuries was 25.9 per 100,000 population. The rate was slightly higher for Blacks (30.1) and Whites (27.3) and lower for Hispanics (19.1) and Asians/Pacific Islanders (9.7). The rate for males (36.6) was more than twice the rate for females (16.1). For all types of unintentional injuries combined, the highest death rate was among those aged 65 years and older (73.3 per 100,000 population). Rates for those aged 15-64 were similar to the overall age-adjusted rate and rates for those under 15 years of age were lower than average. For motor vehicle-related injuries, the highest death rates were among those aged 15-34 and 65 years and over. For drug poisonings, the highest rate (11.5) was among those aged 35-44 years. The age-adjusted death rates for motor vehicle-related injuries, falls, and drug poisoning for males were 2.4 times the rate among females (Table DS33 and Figure DS12). Age-adjusted death rates for unintentional injuries ranged from a low of 18.2 in Somerset County to a high of 55.1 in Salem County, more than double the statewide rate (Table DC10 and Figure DC11).
There were 599 suicides among New Jersey residents in 2004. The age-adjusted death rate was 6.8 per 100,000 population. The highest death rate was in the 45-54 years age group (9.7) (Table DS34 and Figure DS13). The suicide rate was 4.6 times higher among males than females and Whites exceeded the overall rate by 22% (8.3) while rates for Blacks (4.5), Hispanics (3.7), and Asians/Pacific Islanders were 34%, 46%, and 49% below the overall rate, respectively (Table DS35). The rate for White males aged 45-54 years was the highest: 20.8 per 100,000 population (Table DS39). Suffocation, which includes hanging and strangulation, was the most common suicide mechanism (213 deaths), followed by firearms (186) and poisoning (116). Firearms were more likely to be used among those aged 45 and over than any other mechanism. Males were more likely to use firearms (37%) than suffocation (34%), while females were most likely to use suffocation (41%) followed by poisoning (35%). Among all races/ethnicities, suffocation was the most common mechanism except for Whites for whom firearms were slightly more common (Table DS35 and Figure DS15). Among the 14 counties with data sufficient to calculate age-adjusted suicide rates, the lowest was in Hudson (4.2) and the highest was in Ocean (12.0) (Table DC10).
In 2004, there were 405 homicides of New Jersey residents – one fewer than in 2003. The age-adjusted homicide rate was 4.8 per 100,000 population. The highest rate (15.6) was among those aged 20-24 years (Table DS36 and Figure DS14). The homicide rate was 4.6 times higher among males than females. The rate among Blacks was four times higher than the overall rate while the rate for Hispanics was virtually equal to the overall rate and the rate for Whites was one-third the overall rate (Table DS37). The rate for Black males aged 15-24 was the highest: 96.9 per 100,000 population (Table DS39). Firearm was the most common homicide mechanism (252 deaths), followed by the use of sharp objects (66). Sharp objects were more likely to be used on those aged 65 and over than any other mechanism. Firearm was the most common mechanism among each race/ethnicity and sex, however the share of homicides attributable to firearm use were not equal for all. For males, 68% of homicides were via firearms while only 36% of female homicides were. While 74% of homicides of Blacks were due to firearms, 58% of Hispanic and 40% of White homicides were attributable to firearms (Table DS37 and Figure DS16). Only six counties had enough resident homicides to calculate reliable age-adjusted death rates. Of those, the lowest rate (4.4) was in Union County and the highest rate (17.9), in Essex County, was nearly four times the statewide rate (Table DC10).
There were 454 firearm-related injury deaths of New Jersey residents in 2004, a 4% increase from 2003. Of those, 252 (56%) were homicides, 186 (41%) were suicides, 10 (2%) were unintentional, and 5 (1%) were legal intervention. Firearm-related homicides increased 2% from 2003 to 2004. The age-adjusted death rate due to firearms was 5.3 per 100,000 population. The highest death rate was in the 45-54 age group (9.7). The firearm-related death rate was eleven times higher among males than females. The rate among Blacks was three times higher than the overall rate while the rates for Whites and Hispanics were 36% and 40% lower than the overall rate, respectively. The rate for Black males aged 15-24 was highest: 96.9 per 100,000 population. While the number of firearm-related homicides decreased with increasing age, the opposite was true of firearm-related suicides. Unintentional firearm-related deaths were spread across age groups 15 through 54 years (Table DS38 and DS39 and Figure DS17). Of the eight counties with data sufficient to calculate reliable age-adjusted firearm-related death rates, rates ranged from 2.4 in Bergen County to 15.3 in Essex County, nearly three times the statewide rate (Table DC10).
Drug-induced deaths are those with mental and behavioral disorders due to use of drugs, unintentional poisoning, intentional poisoning (suicide or homicide), or poisoning of undetermined intent as the underlying cause of death. There were 712 drug-induced deaths in 2004, a 5% decrease from 2003. The age-adjusted death rate was 8.1 per 100,000 population. The highest death rate (14.8) was among those aged 35-44 years. The rate among males was more than double the rate among females. The rates among Whites and Blacks were 14% and 36% higher, respectively, than the overall rate while the rate among Hispanics was 37% lower than the overall rate (Table DS40 and Figure DS18). Among the 15 counties with sufficient data, the age-adjusted drug-induced death rate ranged from a low of 4.9 in Morris to a high of 17.4 in Atlantic County, more than double the statewide rate (Table DC10).
Alcohol-induced deaths are those with mental and behavioral disorders due to use of alcohol, degeneration of nervous system due to alcohol, alcoholic polyneuropathy, alcoholic cardiomyopathy, alcoholic gastritis, alcoholic liver disease, finding of alcohol in blood, unintentional acute alcohol poisoning, intentional alcohol self-poisoning (suicide), or alcohol poisoning of undetermined intent as the underlying cause of death. There were 468 alcohol-induced deaths in 2004, an increase of 9% over 2003. The age-adjusted death rate was 5.0 per 100,000 population. The highest death rate (14.5) was among those aged 45-54 years. The rate among males was three times the rate among females. Rates varied slightly by race/ethnicity (Table DS41 and Figure DS18). Among the 11 counties with sufficient data, the age-adjusted alcohol-induced death rate ranged from a low of 3.2 in Monmouth to a high of 7.2 in Atlantic and Passaic Counties (Table DC10).
Fatal injuries at workAmong New Jersey residents, there were 127 fatal injuries at work in 2004. Of those, 121 were male and 6 were female. The vast majority of deaths were due to unintentional injuries (105), but there were also 11 homicides and 5 suicides (Table DS42).
NEW CHECKBOX ITEMS
Diabetes checkboxBeginning in 2004, medical certifiers were to answer “Yes”, “No”, or “Unknown” to the question “Did decedent have diabetes?” on the death certificate. Overall, 17% of decedents were reported to have had diabetes. Nearly all deaths with diabetes as the underlying cause of death had “Yes” selected on the checkbox but it is anticipated that future data years will have even better agreement between the checkbox and diabetes as cause of death. Among those with an underlying cause of death other than diabetes, 14% had a positive response on the checkbox, 56% had “No” selected, and 21% were listed as “Unknown” as to whether or not the decedent had diabetes (Table DS43)
Tobacco use checkbox
An item on tobacco use was also added to the death certificate in 2004. Medical certifiers were to answer “Yes”, “No”, “Probably”, or “Unknown” to the question “Did tobacco use contribute to death?” According to this checkbox, in 2004, tobacco use contributed to eight percent of deaths and probably contributed to an additional five percent. Tobacco use was believed to have contributed to 39% of deaths due to chronic lower respiratory disease (CLRD) and probably contributed to an additional 13% of CLRD deaths. Tobacco use contributed or probably contributed to 20% of deaths due to cancer and 17% of deaths due to aortic aneurysm and dissection (Table DS44).
Prior to 2004, the death certificate had the following question: “If female, was she pregnant at death, or any time 90 days prior to death?” In 2004, the pregnancy item was expanded to five categories: Not pregnant within past year, Pregnant at time of death, Not pregnant but pregnant within 42 days of death, Not pregnant but pregnant 43 days to 1 year before death, and Unknown if pregnant within the past year. Responses to the pregnancy item affect the determination of the underlying cause of death and the changes in the item on the certificate greatly increased the number of maternal deaths in 2004. In prior years, the number of maternal deaths fluctuated between 4 and 14. In 2004, the number was 24. Further study will be needed to determine if this is a true increase or a data artifact.A disproportionate percentage of maternal deaths occurred to black women: 57% of maternal deaths vs. 14% of births. Sixty-two percent of maternal deaths occurred to women aged 25-34.
There were two major changes and a few additions to the 2004 death report due to changes in the death certificate and in the processing of the file. For the first time, respondents were able to identify more than one race for the decedent. Only 0.3% of records had two or more races selected in 2004. Full address information was available on the electronic death file for the first time, thereby allowing the geocoding of residence data to correct for inaccurately assigned county and municipality codes. Two new checkbox items were added to the certificate: one asking if the decedent had diabetes and the other asking if tobacco use contributed to death. Additionally, significant changes were made to the pregnancy checkbox item and minor changes were made to the place of death and method of disposition items.
The Technical Notes section contains detailed information on sources of data, quality of data, allocation of data by residence or occurrence, racial and ethnic classification, definitions, rates, cause of death rankings, ICD-10 cause of death codes, and comparability ratios
Department of Health
P. O. Box 360, Trenton, NJ 08625-0360
|Last Modified: Monday, 16-Jul-12 11:31:17|