Demographics And Causes

Not surprisingly, death is much more common in old age than at other times of life. Over 75% of the estimated 2,312,180 persons who died in the United States in 1995 were at least 65 years old. Twenty-one percent were 3564 years old, .4% were 15-34 years old, and only 2% were under age 15. As illustrated in Figure 13-1, specific death rate for both males and females rises gradually during early and middle adulthood and increases steeply in old age, but is higher for males than for females throughout the life span (Anderson, Kochanek, & Murphy, 1997).

Slightly less than 51% of those who died in this country in 1995 were could do to influence what happens to us after death — that it was entirely a matter of God's grace rather than our own actions on this earth—I felt re— lieved and interpreted it as carte blanche to do whatever seemed okay to me and my conscience.

This didn't completely settle the matter in the long run, so for a college course project I decided to interview a sample of people and ask them where they thought they would go when they died. The following responses are rep— resentative:

"Dust to dust, ashes to ashes."

"To play harps and football with the angels."

"To become one with the cosmos."

"To sleep for eternity."

"Anywhere except New York City."

"To a distant planet, after an alien space ship picks me up."

"To Peaceful Valley cemetery, where my parents are buried."

"To the High Sierras or the Pacific

Ocean, where my ashes will be scattered to the winds."

"To heaven to begin a new life."

"To my grave, where I shall await resurrection on Judgment Day."

"To hell if I don't change."

"To Atlanta. That's where I was born, and I have arranged for my remains to be sent there."

To a committed Christian, of course, Christ's answer to the "Quo Vadis?" question was that hewas going to prepare a place for us. Whether that place has many mansions or is just a massive housing development and whether souls fly around on wings or in helicopters was of little concern to an eight—year—old girl to whom I posed the question ofwhere she thought she would go when she died. Her delight— fully refreshing answer, and probably one with which most people deep down would agree, was: "I don't know, but I hope it's a nice place."

Out of the mouths of babes.

males, and slightly more than 49% were females. Figure 13-1 shows that up until the 75—84 age range, the number of deaths and the age—specific death rate are higher for men than for women. The age—specific death rate for men remains higher than that for women in the 75—84 and 85+ age groups, but the number of deaths for women is greater than that for men in those age ranges. This reversal of the ratio of male to female deaths is due to the fact that because males die in greater numbers than females at all ages up to age 75, there are substantially fewer men than women left to die after that age.

Eighty—six percent of those who died in this country in 1995 were whites, 12% were blacks, .4% were American Indian, 1.2% were Asian or Pacific Islander, and 4% were Hispanic (Rosenberg et al., 1996).1 Not only did the greatest numbers of deaths occur in the white and black populations, but the death rates were also higher in those groups than in other racial groups (see

•Hispanics may be of any race, but the great majority identify themselves as white.

5 10 15

Death Rate (Per 100,000 Population in Age Group)

Figure 13-1 Number and rate of deaths in the United States in 1995 by age and sex.

(Based on data from Anderson, Kochanek, and Murphy, 1997.)

5 10 15

Death Rate (Per 100,000 Population in Age Group)

Figure 13-1 Number and rate of deaths in the United States in 1995 by age and sex.

(Based on data from Anderson, Kochanek, and Murphy, 1997.)

Figure 13-2). The lower death rates for American Indians and Hispanics, however, are also influenced by the fact that they are younger populations than whites and blacks. Population age is also a factor in the higher death rates for European and North American countries than for Central and South American and Asian countries. However, the highest death rates in the world are found in African countries, which, though consisting of relatively young populations, also have poorer living conditions (poorer nutrition and sanitation, higher rates of infectious diseases, etc.) than most countries in other parts of the world (Population Reference Bureau, 1997). However, noncom-municable diseases such as cancer, heart diseases, and diabetes cause more deaths than infectious diseases in all areas of the world except India and sub-Saharan Africa. The major reason for the increasing importance of noncom-municable diseases as causes of death throughout the world is the graying of the global population. Another important factor associated with worldwide death rates is smoking, which contributes to heart disease, lung cancer, and other killer diseases (Maugh, 1996).

The 10 most common causes of death in the United States are listed in Figure 13-3. Although heart diseases and malignant neoplasms (cancers) are ranked in all age groups among the 10 causes of death having the highest frequency, the third most frequent cause for all ages combined—cerebrovascular

i_i i I i i i I i , i I i i i I , , , 0 200 400 600 800 1,000

Age-Specific Death Rate (Per 100,000 Population)

Figure 13-2 Death rate in the United States in 1995 by sex and race/ethnicity. (Based on data from Anderson, Kochanek, and Murphy, 1997.)

i_i i I i i i I i , i I i i i I , , , 0 200 400 600 800 1,000

Age-Specific Death Rate (Per 100,000 Population)

Figure 13-2 Death rate in the United States in 1995 by sex and race/ethnicity. (Based on data from Anderson, Kochanek, and Murphy, 1997.)

diseases—does not appear among the top 10 until early adulthood. In addition, below age 25, the highest ranked cause of death is accidents and adverse effects; in the 25-44 age range, it is human immunodeficiency virus (HIV) infection; in the 45-64 age range, it is malignant neoplasms; and in the 65 years and over range, it is diseases of heart. The death rates for particular conditions also vary with sex and ethnicity. Men have a higher death rate than women for HIV infection, malignant neoplasms, pulmonary diseases, liver disease, accidents, suicide, and homicide; women have a higher death rate than men for diabetes mellitus, Alzheimer's disease, cerebrovascular diseases, pneumonia, and influenza. Whites have a higher death rate than blacks for malignant neoplasms, Alzheimer's disease, heart diseases, cerebrovascu-lar diseases, pneumonia and influenza, and suicide; blacks have a higher death rate than whites for HIV infection, diabetes mellitus, accidents and adverse effects, and homicide (Singh et al., 1996). With respect to time of year, the death rate is higher during the winter months of January, February, and March than in other months. Of all areas of the United States, the District of Columbia has the highest death rate and Alaska the lowest (Rosenberg et al., 1996).

Although suicide, homicide, and accidents are not among the top 10

Diseases of heart

Malignant neoplasms

Cerebrovascular diseases

Chronic obstructive pulmonary diseases

Accidents and adverse effects

Pneumonia and influenza

Diabetes mellitus

HIV infection

Suicide

Chronic liver disease & cirrhosis

000 600 400 200 0 50 100 150 200 250 300 Number of Deaths (1,000s) Death Rate (Per 100,000)

Figure 13-3 Number of deaths and death rate in the United States in 1995 by cause.

(Based on data from Anderson, Kochanek, and Murphy, 1997.)

causes of death for all age groups, they are of special interest because they are not diseases. As shown in Figure 13-4, the age-specific death rate for accidents and adverse effects declines from infancy to early adolescence and rises during adolescence and early adulthood. After then, it remains fairly constant until ages 65-74, after which it rises steeply. The high accidental death rate in later life is due primarily to accidents and adverse effects other than those caused by motor vehicles; falls, in particular, are a common cause of fatal accidents in many older people. The accidental death rate for men is substantially higher than for women and slightly higher for blacks than for whites. The age-specific death rate for homicide and legal intervention declines from infancy through early adolescence, reaches a peak during the late teens and early twenties, and then declines gradually for the remainder of the life span. Like the rate of deaths due to accidents, the homicide death rate is substantially higher for men than for women, and higher for blacks than for whites. The age-specific death rate for suicide is lower during childhood than at any other time of life. It increases during the late teens and early adulthood, declines slightly during middle age, and rises again after age 65. The suicide rate is higher for men than for women, and higher for whites than for blacks. The rank order of the causes of death has also varied from year to year

000 600 400 200 0 50 100 150 200 250 300 Number of Deaths (1,000s) Death Rate (Per 100,000)

Figure 13-3 Number of deaths and death rate in the United States in 1995 by cause.

(Based on data from Anderson, Kochanek, and Murphy, 1997.)

65-74 55-64

75-84

65-74 55-64

75-84

45-54 35-44

15-24 5-14

45-54 35-44

Ê Suicide ft Homicide

25-34 bH

Accidents

15-24 5-14

Age-Specific Death Rate (Per 100,000 Population)

Figure 13-4 Age-specific death rates for accidents, homicide, and suicide in the United States in 1995. (Based on data from Anderson, Kochanek, and Murphy, 1997.)

during this century. One trend has been the replacement of acute illnesses with chronic illnesses as the major causes of death. From 1900 to 1920, influenza and pneumonia, tuberculosis, and gastroenteritis were close to the top of the list of causes of death in the United States. Medical breakthroughs in the prevention and treatment of these conditions have resulted in the near-disappearance of tuberculosis and a dramatic reduction in deaths caused by influenza and gastroenteritis. Pneumonia and influenza are still in the top 10, but they dropped from first place in 1900 to sixth place in 1995.

Ideas and feelings about death have varied throughout human history. The preoccupation with wars, death, and disease during the late Middle Ages produced paintings and sculpture depicting the triumph of death, the dance of death ( danse macabre ), and memento mori urging people to "seize the day" ( carpe diem ) because their time was limited. Interest in the "maggotry" of death during the fourteenth and fifteenth centuries found expression in its physical aspects. Blood, decaying fish, worms, and other "realistic" images

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