New Jersey Health Statistics 1996
YEARS OF POTENTIAL LIFE LOST BY CAUSE
Analyses of patterns of cause-specific death rates, both crude and age-adjusted, have traditionally been used to examine the relative importance of the various causes of death acting upon a population. Since most deaths occur in the older age groups, these measures are heavily weighted toward the mortality experience of the elderly. From a public health perspective, serious attention must also be directed toward the prevention of premature deaths, i.e., deaths that occur earlier than the average life expectancy or prior to some selected age, such as 65. The New Jersey Department of Health has recognized the importance of this concept by designating the prevention of premature death as one of two overall goals in Healthy New Jersey 2000, New Jersey's health agenda for the decade of the 1990s (New Jersey Department of Health, 1991).
A measure used to reflect the trends in premature mortality is years of potential life lost (YPLL). YPLL represents the summation of all of the years of life not lived to a defined upper limit (for these purposes set at age 65) by those who died during the year of interest, at ages less than the specified upper limit (NCHS, 1994). Deaths at younger ages receive a greater weight in computing YPLL than do deaths at older ages, e.g., one death at age 20 adds 45 years to YPLL, while a death at age 64 adds only one year to YPLL. Thus the death of one 20 year old is equivalent to the deaths of 45 persons aged 64 in the computation of years of potential life lost.
There were 338,027 years of potential life lost to age 65 by New Jersey residents who died in 1996 before reaching their 65th birthdays. The major contributor to YPLL in New Jersey was cancer, followed by unintentional injuries and HIV infection (Table M15 and Figure M4). Other major contributors to YPLL were heart disease and certain conditions originating in the perinatal period (early infant mortality). In the U.S. in 1996, the leading causes of YPLL were unintentional injury, cancer, heart disease, and HIV infection, in that order.
The New Jersey YPLL rate was slightly lower than the rate in the nation as a whole. Additionally, the ranking of the ten leading causes of YPLL and the rates per 100,000 population under 65 differed in New Jersey and the nation (Table M15 and Figure M5). New Jersey's rate of YPLL was higher than the United States rate for cancer, HIV infection, and early infant mortality. The YPLL rate from each type of injury (unintentional, suicide, and homicide) was higher in the U.S. than in New Jersey, as were the YPLL rates from heart disease and congenital anomalies. The YPLL rates for chronic liver diseases and cirrhosis and stroke were virtually identical for New Jersey and the nation as a whole.
Cancer of all sites was the leading cause of YPLL in 1996 in New Jersey, responsible for 58,664 years of potential life lost to age 65 from deaths that occurred in 1996. Of deaths due to cancer, the major contributor to YPLL was cancer of the lung and bronchus, which was responsible for 12,355 YPLL or slightly more than one-fifth of the total YPLL due to cancer (Figure M6). The next leading contributor to the YPLL from cancer was female breast cancer with 7,220 YPLL. Cancer of digestive organs other than the colon and rectum caused 6,854 years of potential life to be lost in 1996. Cancer of the genitourinary system accounted for 6,297 YPLL, of which 1,415 were due to cervical cancer and 590 to prostate cancer. Cancer of the colon and rectum caused 4,460 YPLL.
Unintentional injury was the second leading cause of premature death in New Jersey as measured by YPLL. There were 1,533 unintentional injury deaths of New Jersey residents under the age of 65 in 1996: 618 from injuries resulting from motor vehicle accidents and 915 from other unintentional injuries. The major cause of YPLL from unintentional injury was death from motor vehicle-related injuries, accounting for 19,183 YPLL. Under the age of 65, the greatest frequency of motor vehicle-related deaths occurred in the 15 through 24 year age group (168 deaths), with substantial numbers of deaths also in the 25 through 34 year age group (134) and among 35 through 44 year olds (115). Motor vehicle-related injury deaths accounted for 43.3 percent of YPLL due to unintentional injuries in 1996 (CHS, 1998b).
The next most frequent cause of YPLL due to unintentional injuries was accidental poisoning by drugs. This category includes accidental overdose of a drug, wrong drug given or taken in error and drug taken accidentally, but excludes a correct drug properly administered in therapeutic dosage and administration of a drug with suicidal or homicidal intent. More than one-third (35.6%) of the YPLL attributed to unintentional injury deaths was due to accidental drug poisoning. Nearly three-fourths (73.7%) of total drug poisoning deaths were of individuals 25 through 44 years of age. Three other categories of unintentional injuries which made substantial contributions to YPLL in 1996 were drownings (3.8% of unintentional injury YPLL), deaths due to falls (3.5%), and deaths due to fire and flames (3.0%) (CHS, 1998b).
The third leading cause of YPLL among New Jersey residents in 1996 was HIV infection, which was responsible for 43,249 years of potential life lost. This represents a 17,746 year reduction (a 29.1% decrease) from the HIV infection YPLL of 1994 (Martin, R.M., et. al., 1996). Of the total years lost to HIV infection in 1996, 60.3 percent were due to premature deaths of black residents (Table M16). The vast majority of the years of potential life lost to HIV infection occurred in persons aged 25 through 44. A total of 35,020 years of potential life were lost to HIV infection by persons in this age group; this represented 81.0 percent of the total HIV infection YPLL (CHS, 1998b).
Years of Potential Life Lost by Race
In 1996, 107,979.5 years of potential life were lost by black New Jerseyans who died before their 65th birthdays (Table M16). White residents under the age of 65 accounted for 212,614 YPLL from deaths that occurred in 1996. While blacks account for 15.5 percent of New Jersey's population under the age of 65, premature deaths of black residents represent almost one-third (32.0%) of total YPLL. At the same time, white residents are 78.8 percent of the state's population under age 65, but accounted for only 62.9 percent of the total YPLL. The YPLL rates differed dramatically by race: the rate of YPLL among blacks (10,132.3 per 100,000 black population under 65) was 2.6 times the white rate (3,916.0 per 100,000 white population under 65).
The rates of YPLL for each of the 10 leading causes of YPLL among black residents were higher for blacks than the corresponding rates for whites (Table M16 and Figure M8). Some of the discrepancies in rates were quite dramatic. The black rate of YPLL due to homicide was 8.9 times the white rate; the black/white ratio of YPLL rates due to HIV infection was 7.9, the pneumonia/influenza ratio was 4.1, the ratio for certain conditions surrounding the perinatal period (early infant mortality) was 2.7, and the ratio for stroke was 2.7. Other leading causes of YPLL in the black population with relatively high black/white ratios included diabetes (2.2), congenital anomalies (1.9), unintentional injury (1.8), and diseases of the heart (1.6). Not only were the black YPLL rates higher than the white rates for HIV infection and homicide, the years of life lost by blacks actually exceeded the white YPLL for these two causes by 9,176 and 3,447 years, respectively.
Of the 10 leading causes of YPLL among either black or white residents, only suicide had a higher rate in whites than in blacks (186.6 and 160.0, respectively). Suicide was the sixth leading cause of YPLL among white residents under 65 and twelfth among blacks.
HIV infection continued to be the leading cause of premature death among New Jersey's black population in 1996, accounting for 26,080 years of potential life lost before age 65 or 24.2 percent of the total YPLL for blacks. HIV infection was the fourth leading cause of YPLL among white residents. Not only was the black YPLL rate almost eight times the white rate, the years of life lost to age 65 by blacks to HIV infection actually exceeded the white YPLL for this cause group (Figure M7). The age group accounting for most of the black premature deaths due to HIV infection was 25 through 44 years. YPLL for this age group totaled 20,360 years or 78.1 percent of the total YPLL due to HIV infection among blacks (CHS, 1998b).
Unintentional injuries ranked second as a cause of YPLL among both blacks and whites in 1996, accounting for 11,533.5 and 31,896 YPLL, respectively (Table M17). Motor vehicle-related fatalities were the leading cause of unintentional injury YPLL among whites, accounting for 45.7 percent of white unintentional injury YPLL. Unintentional drug poisonings were the leading cause of unintentional injury YPLL in blacks; the YPLL rate among blacks was 2.3 times the rate among whites. Other major causes of unintentional injury deaths among both blacks and whites under 65 were deaths from drownings, falls, and fire and flames. The discrepancy among YPLL rates among whites and blacks was particularly great in deaths from fire and flames: the black YPLL rate was 7.1 times the white rate in 1996.
ranked first as a cause of YPLL among New Jersey's white population
in 1996, accounting for 46,024 years of life lost to age 65 and
third among the black population as a cause of YPLL, responsible
for 11,149 YPLL. The overall YPLL rate among blacks was 1.2 times
the white rate, 1,046.2 and 847.7, respectively (Table M18). Among
both black and white populations, cancer of the female breast had
the highest rate of YPLL, followed by cancer of the lung and bronchus.
Rates of YPLL were higher among blacks than whites for many types
of cancer. The ratios of black/white YPLL rates were particularly
high for cancer of the lip, oral cavity and pharynx (3.8), cancer
of the prostate (2.8), cervix uteri cancer (1.6), hematopoietic
tissue cancer, except leukemia (1.6), and cancer of the digestive
organs, excluding the colon and rectum (1.6). For cancer types with
sufficient numbers of deaths and/or substantial differences by race,
white YPLL rates exceeded black rates for cancer of the nervous
system (by a ratio of 2.8:1) and leukemia (1.4:1).
Certain conditions surrounding the perinatal period (early infant mortality) ranked fourth as a cause of YPLL among black residents and fifth among whites. This cause group (ICD-9 codes 760-779) includes disorders relating to short gestation and unspecified low birth weight, respiratory distress syndrome and other causes. This group of causes was responsible for 10.0 percent of the total black YPLL in 1996.
Years of Potential Life Lost by Sex
Years of potential life lost differ by sex, both in terms of volume of years lost and in the relative ranking of causes responsible for premature death (Figure M9 and Table M19). In 1996, early death led to 212,212.5 YPLL among males and 125,729.5 among females. The rates per 100,000 sex-specific population under 65 were 6,184.0 and 3,637.3, respectively (a male/female ratio of 1.7).
The leading cause of YPLL among males in 1996 was unintentional injuries, which ranked fourth among females in 1996 (Table M19). The rate of YPLL due to unintentional injuries per 100,000 males under the age of 65 was 2.9 times the comparable rate for females (Figure M10).
HIV infection ranked second as a cause of YPLL for both males and females in 1996. HIV infection had been the leading cause of YPLL for males in both 1992 and 1994 (Martin, R.M., et. al., 1995 and Martin, R.M., et. al., 1996). In 1996, the YPLL rate for males was 2.3 times the rate for females.
was the leading cause of YPLL among females, responsible for 30,187.5
YPLL. Cancer ranked third as a cause of YPLL among males, with a
YPLL rate 5.1 percent lower than the female rate. The types of cancer
which led to YPLL differed by sex (Table M20). In every cancer site
not specific to sex, male YPLL rates were higher than female rates,
however, the total YPLL rate for females was higher than the rate
for males. This is due primarily to the YPLL for female breast cancer,
which exceeded all other site-specific cancer YPLL rates. For those
cancer sites for which the rates for males were higher than the
female rates, some had ratios of male/female YPLL rates which were
quite high: the lip, oral cavity and pharynx cancer YPLL rate was
3.1 times as high in males as in females, while the YPLL rate in
cancer of the urinary organs was 1.9 times as high in males as in
females. YPLL rates for cancer of the nervous system, digestive
organs excluding the colon and rectum, and hematopoietic tissue
excluding leukemia were also substantially higher in males than
Among other leading causes of YPLL, major discrepancies in male/female rates occurred in suicide (a male/female ratio of 3.9), homicide and legal intervention (a ratio of 3.4), chronic liver disease and cirrhosis (a ratio of 2.8), and heart disease (a ratio of 2.4). With the exception of cancer, the male rates for each of the 10 leading causes of YPLL were higher than the corresponding female rates (Figure M10).
© State of New Jersey, 1996-2004