MORTALITY

Statistical Overview
There were 73,981 deaths of New Jersey residents in 1999 (Table M3). This represents a 4.0 percent increase over 1998. The crude death rate was 908.5 per 100,000 population and the age-adjusted rate was 857.7 (Table M1 and Figure M1). The age-adjusted mortality rate decreased 10.9 percent from 1989 to 1999 despite a 2.5 percent increase between 1998 and 1999 (Table M1). The number of deaths, crude death rate, and age-adjusted death rate all increased nationally, also, though not as steeply as in New Jersey (Hoyert, et al, 2001). The age-adjusted death rate for New Jersey males was 40.4 percent higher than the rate for females and the age-adjusted death rate for blacks was 31.0 percent higher than the rate for whites in 1999 (Table M2 and Figure M2). The ten leading causes of death remained unchanged from 1998: heart disease, cancer, stroke, chronic respiratory disease, diabetes, unintentional injuries, influenza and pneumonia, septicemia, kidney disease, and Alzheimer's disease (Table M11).

For persons born in New Jersey in 1999, average life expectancy was 77.3 years. For females, it was 79.6 years and for males it was 74.7 years. Life expectancy for whites was 77.8 years and 72.0 years for blacks (Table M10 and Figure M4).

Technical Changes
The data in this report may differ from comparable data presented in previous reports in this series because of four major changes in the reporting and analysis of mortality data. Because of these changes, assessment of trends in death data should be undertaken with caution.

First, the classification of causes of death changed in 1999. The International Classification of Diseases (ICD) is a product of the World Health Organization and is used worldwide. The United States adopted the Tenth Revision of the ICD (ICD-10) in 1999. The revision not only effects the codes and names assigned to causes of death, it also effects the rules for selecting the underlying cause of death and the grouping of causes for tabulation and selection of leading causes of death. Because of this, there were dramatic increases or decreases in the numbers of deaths due to certain causes between 1998 and 1999. To make deaths coded under the ninth revision (ICD-9) comparable to current data, the National Center for Health Statistics (NCHS) computed preliminary comparability ratios for 113 selected causes of death and 130 selected causes of infant death. When applied to deaths coded in accordance with ICD-9, the comparability ratios allow for trend analysis by eliminating differences due solely to the change in ICD. Tables of comparability ratios used in this chapter are given in Tables A-B.

Second, the federal Department of Health and Human Services adopted a policy that the standard population used for age-adjustment be changed from the US 1940 population to the US 2000 projected population. Therefore age-adjusted rates are now higher because the 2000 population has an older age distribution than in 1940 and are closer to corresponding crude rates because we are close to the standard population year. Rates for 1989-1998 have been recalculated using the new standard (Table M1 and Figure M1). The change in standard does not affect trends once rates are recalculated, but differentials in rates between race and sex groups are affected (Hoyert, et al, 2001).

Third, the underlying cause of death from the multiple cause of death (MCD) file compiled by NCHS was used to produce the tables in this report. In past reports, the underlying cause from the single cause of death (SCD) file compiled internally was used. There are several differences between the two files. Cause of death information on MCD files is coded automatically through use of a specialized computer software package, while the SCD files are coded manually by nosologists (persons trained to classify diseases in accordance with an organized list of diseases and injuries). This may lead to differences in the selection of the underlying cause of death. The MCD file yields full information on resident deaths occurring out of state, while the SCD file contains full information from some states but limited information from other states and New York City. Missing race, sex, and county of residence are imputed on the MCD file (missing data are assigned a value based on an algorithm), while the SCD file leaves them blank. The use of the MCD file will lead to increases in both the number of deaths and death rates by race and, to a lesser extent, by county and sex, since race is not stated more frequently than county and sex. NCHS's cut-off date for the receipt of 1999 death records was June 30, 2000. So, any records sent to the state registrar after that date will not be in the MCD file. However, this number is negligible. The MCD file does not separately code residence information for municipalities with populations less than 10,000.

Fourth, since Asian and Pacific Islander and Hispanic ethnicity reporting on death certificates in New Jersey and the rest of the country is known to be undermeasured, mortality data are presented separately for Asians and Pacific Islanders (Tables MA1-MA9) and for Hispanics (Tables MH1-MH9) in a supplemental section near the end of this chapter. In Tables M1-M39, Asians and Pacific Islanders are included in the Other race group. Since Hispanics can be of any race, Hispanic decedents are included in the race group indicated on their death certificates in Tables M1-M39.

Causes of Death
The top ten causes of death remained unchanged from 1998 after ICD-10 comparability modifications were made to the 1998 data (Table M11). Comparability modifications caused influenza and pneumonia to drop from the fifth leading cause of death to seventh in 1998, thereby causing diabetes and unintentional injuries to increase to fifth and sixth, respectively (Table M11). Alzheimer's disease became the tenth leading cause of death in 1998, after comparability modification, and remained tenth in 1999 (Table M11). The ten leading causes of death accounted for 80.9 percent of deaths in 1999 (Table M12). The two leading causes of death among both sexes and all races (heart disease and cancer) accounted for 56.3 percent of all deaths. Stroke and chronic respiratory disease were the third and fourth leading cause of death, respectively, for both sexes. Unintentional injury was the fifth leading cause of death among males, while it was eighth among females (Table M19). HIV disease was the third leading cause of death among blacks and the eighteenth among whites (Table M20). Cancer returned as the leading cause of death among residents 25-44 years old for the first time since the early 1990s when it was overtaken by unintentional injuries (Tables M12).

There were 301,830 years of potential life lost (YPLL) before age 65 among New Jerseyans in 1999 (Table M21). YPLL is the sum of all the years of life not lived by persons dying before reaching age 65 and is used as a measure of premature death. For the total population, for males, and for whites, cancer was the leading cause of YPLL, followed by unintentional injuries and heart disease (Tables M21-M23 and Figures M8, M10, M12). Cancer and perinatal conditions were the leading causes of YPLL among females (Table M22 and Figure M10). Among blacks, HIV disease was the leading cause of YPLL, followed by perinatal conditions (Table M23 and Figure M12).

The age-adjusted death rate due to cancer was 8.8 percent lower in 1999 than it was in 1994. Age-adjusted deaths rates for most cancer sites decreased over the time period (Table M24). In 1999, trachea, lung, and bronchus remained the most common cancer mortality site, followed by cancer of the colon, rectum, and anus and cancer of the breast (Table M24). Nearly 58 percent of cancer deaths occurred among those aged 65-84 (Table M25). In 1999, the male age-adjusted death rate for cancer of the trachea, lung, and bronchus was 77.2 percent higher than the rate for females (Tables M26-M27).

Firearms caused 366 deaths in 1999. Of those, 195 were suicides, 153 were homicides, 8 were accidental, 5 were legal intervention, and 5 were of undetermined intent (Tables M30 and M37). The firearm death rate among males was 7.4 times the rate among females and the rate among blacks was 2.9 times the white rate (Table M30A). Drug-related causes such as mental and behavioral disorders due to psychoactive substance use, accidental overdoses, and intentional poisonings resulted in 757 deaths, a 10.0 percent decrease from the comparability-modified 1998 number of deaths (841) (Table M31). Meanwhile, alcohol-related causes such as mental and behavioral disorders due to alcohol use; degeneration of nervous system due to alcohol; alcoholic polyneuropathy, cardiomyopathy, gastritis, and liver disease; finding of alcohol in blood; and accidental and intentional alcohol poisoning increased 10.9 percent from the comparability-modified 1998 number (411) to 456 deaths in 1999 (Table M32). In 1999, the drug-related death rate among males was 3.1 times that of females and the alcohol-related death rate among males was 3.4 times the rate among females (Tables M31-M32).

Infant, Fetal, and Maternal Mortality
The number and rate of infant deaths increased slightly from 1998 (Table M40). The infant mortality rate among black non-Hispanics remained more than three times as high as the rate among white non-Hispanics (Table M41). Over seventy percent of infant deaths occurred in the neonatal period (within the first 27 days of life). Infants who were part of a multiple birth were six times as likely to die within the first year of life as singletons. Mortality was negatively related to birth weight and gestational age. Infants whose mothers received no prenatal care were ten times as likely to die within the first year of life as those whose mothers received early prenatal care. Infant mortality rates were twice as high for infants of unmarried mothers versus married mothers and for mothers who smoked during pregnancy versus mothers who did not smoke during pregnancy (Table M44). Sixty percent of infant deaths had a medical risk factor reported on their birth certificate. Previous preterm or small-for-gestational-age infant, incompetent cervix, hydramnios/oligodramnios, and lung disease were the most commonly reported medical risk factors among infant deaths. Of newborns whose mothers had an incompetent cervix, 8.2 percent died within the first year of life (Table M45). Disorders related to short gestation and low birth weight, congenital malformations, and respiratory distress syndrome remained the three leading causes of infant deaths (Table M46).

The fetal mortality rate was 10 percent higher than it was in 1998 (Table M40). Additional years of data are needed to determine if this is a true increase in the rate or merely a one-time anomaly. As with infant deaths, plurality, low birth weight, short gestation, lack of prenatal care, unmarried mothers, and maternal smoking are each correlated with higher rates of fetal mortality (Table M47). The fetal death rate among black non-Hispanics was approximately twice as high as the rate for white non-Hispanics and Hispanics (Table M48). Cord and placenta complications were the leading cause of fetal deaths in 1999 (Table M49).

The Technical Notes section contains information on sources of data, allocation of data by residence or occurrence, quality of data, racial and ethnic classification, definitions, rates and ratios, and cause of death rankings.

For additional information on age standardization of death rates, see the New Jersey Center for Health Statistics publication Age Standardization of Death Rates in New Jersey: Implications of a Change in the Standard Population and the National Center for Health Statistics publication Age Standardization of Death Rates: Implementation of the Year 2000 Standard.

For additional information on the Tenth Revision of the International Classification of Diseases (ICD-10), see the National Center for Health Statistics publications Comparability of Cause of Death Between ICD-9 and ICD-10: Preliminary Estimates and Deaths: Final Data for 1999.

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