Update: Mortality Attributable to HIV Infection Among Persons Age 25 to 44 Years--United States, 1994

During the 1980s, HIV infection emerged as a leading cause ofdeath in the United States. In 1993, HIV infections became themost important cause of death among persons age 25 to 44 years.This report updates national trends in deaths caused by HIV infectionin 1994.

Provisional estimates of deaths in 1993 and 1994 were based ona 10% sample of death certificates of US residents filed in all50 states and the District of Columbia. Demographic data werereported by funeral directors, and causes of death were reportedby physicians, medical examiners, or coroners and encoded accordingto the International Classification of Diseases, Ninth Revision.Underlying causes of death were classified into the categoriesin CDC's "List of 72 Selected Causes of Death" for ranking.Rates were calculated using mid-year US population estimates,based on data compiled by the US Bureau of the Census. Informationon Hispanic ethnicity and races other than white and black wasunavailable in the provisional mortality data; each race includesHispanics.

In 1994, an estimated 41,930 US residents died from HIV infection,a 9% increase over the estimated 38,500 deaths in 1993. Of the41, 930 deaths in 1994, 3% were in individuals under age 25 years;72% in 25 to 44 year olds; and 25% in those age 45 or older. HIVinfection was the eighth leading cause of death overall, accountingfor 2% of all deaths. Among persons age 25 to 44 years, HIV infectionwas the leading cause of death, accounting for 19% of deaths inthis age group. In 1994, HIV infection became the fourth leadingcause of years of potential life lost before age 65, or YPLL-65(compared with fifth in 1993), accounting for 9% of YPLL-65 fromall causes.

Among men age 25 to 44 years, HIV infection was the leading causeof death overall (23% of deaths; Figure 1) and was responsiblefor 20% and 32% of deaths and in white and black men in this agegroup, respectively. HIV infection was the third leading causeof death for all women 25 to 44 years old (11% of deaths; Figure2), the fifth leading cause for white women in this age group(6% of deaths), and the leading cause for black women (22% ofdeaths).

In 1994, the death rate from HIV infection per 100,000 populationamong persons age 25 to 44 years was almost four times as highfor black men (177.9) as for white men (47.2) and nine times ashigh for black women (51.2) as for white women (5.7). Comparedwith 1993, the rate for white men in 1994 was similar (47.5 and47.2, respectively), and rates for the three other gender-racialgroups continued to increase: The percentage increase was 13%for black men, 28% for black women, and 30% for white women (Fig3).

Editorial Note from the CDC

This analysis of provisional mortality data for 1993 and 1994indicates a continuing increase in HIV infection as a leadingcause of death in the United States, particularly among personsage 25 to 44 years. Among persons in this age group, HIV infectionbecame the most common cause of death for black men in 1991, forall men (all racial/ethnic groups combined) in 1992, and for whitemen in 1994. HIV became the third leading cause of death amongwomen in this age group in 1994. In addition, as reflected byYPLL-65, HIV infection has become a leading cause of prematuremortality.

Because this analysis was based on the underlying cause of deathrecorded on death certificates, the findings in this report probablyunderestimate the impact of HIV infection on mortality in theUnited States. Previous studies have indicated that, among personsage 25 to 44 years, deaths for which HIV infection was designatedthe underlying cause represent approximately two- thirds to three-fourthsof all deaths attributable to HIV infection. The estimated numberof death certificates with any mention of HIV infection (ie, underlyingor nonunderlying cause) in 1994 was 48,000 (CDC, unpublished data,1995), compared with the approximately 42,000 of certificateson which HIV was listed as an underlying cause. Based on survivalanalysis of cases reported to CDC through the AIDS surveillancesystem-which includes other sources in addition to data from deathcertificates-and the completeness of reporting of AIDS cases andof deaths, an estimated 55,000 to 60,000 persons with AIDS diedin 1994 (CDC, unpublished data, 1995).

Trends in HIV-related mortality reflect changes in the demographicpatterns of the HIV epidemic. For example, from 1993 to 1994,the death rate for HIV infection for white men age 25 to 44 yearsdid not change, and rates for women and black men increased; in1994, the rate for black women age 25 to 44 years surpassed thatfor white men in that age group. The increasing death rate forwomen affects the care of their children: The estimated 80,000HIV-infected women of childbearing age who were alive in 1992will leave approximately 125,000 to 150,000 children when theydie during the 1990s. Racial differences in death rates for HIVinfection probably reflect social, economic, behavioral, and otherfactors associated with HIV transmission risks. Such factors arebeing addressed through prevention efforts designed to meet theneeds of specific communities.

Because of the prolonged period from initial HIV infection toonset of severe HIV disease (AIDS), recent trends in HIV-relatedmortality reflect trends in HIV transmission several years earlier.Similarly, trends in HIV-related mortality in several years willindicate, in part, the effectiveness of current efforts to preventHIV infection. Despite recent increases in HIV-related mortality,decreases in the percentages of HIV-related deaths resulting fromparticular opportunistic infections (pneumocystosis, cryptococcosis,and candidiasis) suggest some success in the treatment and preventionof opportunistic infections resulting from HIV infection and underscorethe importance of following recently published guidelines forpreventing HIV-related opportunistic infections. (Single copiesof this report will be available until February 16, 1997, fromthe CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville,MD 20849-6003 [telephone: (800) 458-5231 or (301) 217-0023).

Adapted from Morbidity and Mortality Weekly Report, vol45, no 6, February 16, 1996.