Comparability of Mortality Statisticsbrief summary of the statistical design to esti-mate the numerators of the comparability ratios used in this report is given in appendix IV; and

DATA EVALUATION AND METHODS RESEARCHSeries 2Number 66

Comparability of

Mortality Statistics

for the Seventh and Eighth Revisionsof the International Classificationof Diseases,

United States

DHEW Publication No. (HRA) 76-1340

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Resources Administration

National Center for Health Statistics

Rockville, Md. October 1975

Library of CongressCataloging in Publication Data

Kkbba, A. Joan.Comparability of mortality statistics for the seventh and eighth revisions of

Intcrnationai classification of diseases, United States.

(Vital and heaIth statistics: %rics 2, Data from the national vital statistics system;66) (DHEW publication; no. (HRA) 76-1340)

Includes bibliographical refcmnccs.Supt. of Dots. no.: I{F, 20.6209:2/66

the

no.

1. ~osology. 2. 13eath–Causes. 3. United States–Statistics, hlcdical. I. J)olman, Alice B.,joint author. II. United St~tcs. National Center for Ilcaltll stati~tjc~. ~nternationalclassification of diseases, adapted for usc in the United States. 111.Title: Comparability ofmortality statistics :.. IV. Series: United States. National Center for Health Statistics. Vitaland hcdth statistics: Series 2, Data cvaluat ion and methods research; no. 66. V. Series:United States. Dept. of lIcalth, Education, and Welfare. Eli{EW puljlication; no. (HRA)76-1340. [13NLh4: 1. Classification. 2. hloriality-U.S. W’2A N 148vb no. 66]RA409.U45 no. 66 [RBI15] 312’.07’23 “ [312’.2’0723]ISBN 0-8046-0039-9 75-619043

NATIONAL CENTER FOR HEALTH STATISTICS

HAROLD MARGULIES, M. D., Acting Director

ROBERT A. ISRAEL, Acting Deputy Director

GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Directorfor Data Systems

EDWARD E. MINTY, Associate Director for Management

PETER L. HURLEY, Acting Associate Director for Operations

JAMES M. ROBEY, Ph. D., Associate Director for Program Development

ALICE HAYWOOD, Information Officer

DIVISION OF VITAL STATISTICS

JOHN E. PATTERSON, DirectorALICE M. HETZEL, Deputy Director

ROBERT J. ARMSTRONG, M. S., Chiefi Mortality Statistics Branch

Vital and Health Statistics-Series 2-No. 66

●

✎

DHEW Publication No. (HRA) 76-1340Library of Congress Catulog Card Number 75-619043

u

PREFACE

It has been the practice to revise the International Classification ofDiseases every 10 years since 1900 to keep abreast of medicaI knowledge.Each decennial revision has produced breaks in the comparability ofcause-o f-death statistics. The degree of discontinuity resulting from theintroduction of the Eighth Revision, used beginning with data year 1968, hasbeen considerable for a number of causes of death. An adequate presentationof mortality trends without reference to these discontinuities is impossible.The authors acknowledge with pleasure that special thanks are due toBernice Wilkins, forrnerly Statistician, National Center for Health Statistics,for her assistance in identifying some of the important changes between theSeventh and Eighth Revisions that resulted in these discontinuities. Gratefulappreciation is also expressed to Jeffrey D. Maurer and Evelyn J. Glass forhelp in the preparation of the tables in this report.

●

iii

CONTENTS

.

+

Page

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1.

2.

3.

4.

5.

6.

7.

8.

9.

Scope ofthe Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Changes in Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Meaning ofComparability Ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3UseofRatios asRevisionFactors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Diseases of Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5AIIDiseases of Heart (ICDANos. 390-398, 402,404,410-429) . . . . . . . . . . . . . 5Major Components ofDiseases of Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Malignant Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1?All MalignantNeoplasms(ICDANos. 140-209) . . . . . . . . . . . . . . . . . . . . . . . . 17Major Components of Malignant Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Cerebrovascular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Influenza and Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Certain Causes ofMortality inEarly Infancy . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Arteriosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Bronchitis, EmPhwema, and Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45All Bronchitis,!Ernphysema, and Asthma (ICDANOS.490493) . . . . . . . . . . . . . 45Major Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

10. Cirrhosis of Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

11.Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

12. Congenital &omalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

13. Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

14. NTephritis anclNephrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

15. Peptic Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....o.o””oc. 60

List of I)etailed Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 61

Appendix I. Components of Comparability Ratios for 15 Leading Causes of Death andTheirMajor Subcategories.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Appendix II. Technical Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Death Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Population Bases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Appendix III. The United States Standard Certificate of Death, 1968 Revision . . . . . . 80.

Appendix IV.BnefSummaryof Statistical Design . . . . . . . . . . . . . . . . . . . . . . . . 82General PkmforD eathsatAllAges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Appendix V. Comparability Ratio for Major Cardiovascular Diseases . . . . . . . . . . . . 85

Appendix W. Notes for Usein Primwy Moti~ity Coding forthe Eighth Revision . . . . 86

Appendix VII. Assignment by the Eighth Revision of Deaths That by the seventhRevision Were Assigned to Malignant Neoplasm of Other and Unspecified Sites(ICDN0.199) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

SYMBOLS

Data not available ---------------------------------------- ---

Category not applicable ------------------------------- . . .

Quantity zero ---------------------------------------------- -

Quantity ,more than O but less than 0.05 ----- 0,0

Figure does not meet standards ofreliability or precision ------------------------------ *

vi

COMPARABILITY OF MORTALITY STATISTICSFOR THE SEVENTH AND EIGHTH REVISIONS OF THE

INTERNATIONAL CLASSIFICATION OF DISEASESA. Joan IUebba, Statistician, Division o,f Vital Statistics, and Alice B. Dohnan, l%ledical Codification

Specialist, Office of International Statistics

INTRODUCTION

Scope of the Report

During 1900-1969 causes of death were clas-sified according to eight revisions of the Inter-national Classification of Diseases (ICD). Theserevisions are made about every 10 years toreflect progress in mediczd knowledge. The revi-sion in use in the United States beginning withdata yea 1968 is the Eighth Revision Inter-national Classification of Diseases, A dap ted forUse in the United States, 1965 (hereinafterdenoted by ICDA).

This report presents the principaI changes inclassification and coding procedures for the 15leading causes of death in 1969 and their majorcomponents. These 15 leading causes and theircomponents are included among the 48 causesshown in tables 1 and 2. hleasures of thecomparability of mortality statistics between1967 and 1968 are shown for these 48 causes inappendix I. The 15 leading causes accounted for89 percent of the 1,921,990 deaths thatoccurred in the United States in 1969 (table A).

A description of the sources of data andof rates and other terms is @cn in appendix II,

Table A. Deaths and death rates for the 15 leading causes of death: United States,1969

[ Rates pm 100,000 csrimaccd pop.dat[on]

RankCause of death (Eighth Revision, International Classifica-

tion of Diseases, Adapted, 1965)

I

.,. All causes ---------------------------------------------

1 Diseases of heart --------------------- 39O-398,4O2 ,404,410-4292 Malignant neoplasms, including neoplasms of lymphatic and

hematopoietic tissues --------------------------------l4O-2O93 Cerebrovascular diseases ------------------------------430-4384 Accidents -------------------------------------------E8OO-E949

Motor vehicle accidents ---------------------------E8lO-E823All other accidents ---------------------E800-E807,E825-E949

5 Influenza and pneumonia -----------------------470-474,480-4866 Certain causes of mortality in early

infanty --------------------------76O-769.2,769.4-772,774-7787 Diabetes mellitus -----------------------------------------2508 Arteriosclerosis ------------------------------------------4409 Bronchitis, emphysema, and asthma ---------------------490 -493

10 Cirrhosis of liver----------------------------------------57l11 suicide ---------------------------------------------E95o-E95912 Congenital anomalies----------------------------------740-75913 Homicide--------------------------------------------E960-E97814 Nephritis and nephrosis

J

-------------------------------580-58415 Peptic ulcer------------------------------------------53L-533

. . . All other causes -------------------------------------Residual—. .-— .- .———— _______ ______ . . _ _

Number Rate

1,921,990 951.9—

739,265 366.1

323,092 160.0207.179 , 102.6116;385 ~ 57.655,791 ‘ 27.660,594 30.068,365 33.9

43, 17138.54133;06331,14429.86622;36417,00815,477

9,4179,312

218,341———

21.419.116.415.414.811.1

8.47.7

:::108.1

——

1

“Tcclmical Notes. ” A copy of the standardcertificate of death adopted with some modifica-tions i>y most States is shown in appendix III. Abrief summary of the statistical design to esti-mate the numerators of the comparability ratiosused in this report is given in appendix IV; andthe comparability ratio for the group title Majorcardiovascular diseases (ICDA Nos. 390-448) isgiven in appendix V. Notes for use in primarymortality coding for the Eighth Revision areshown in appendix VI.

Changes in Methodology

A review of earlier approaches made toprovide guidelines to the comparability of thetitles from revision to revision of the Interna-tional Classification of Diseases (ICD ) makes itclear that progress has been made over the years.But undoubtedly even the systematic methodfor evacuating breaks in comparability ofmortality statistics in the transition from theSeventh to the Eighth Revision will leave thereader with unanswered questions that point tothe need for further development of the methodfor evaluating more details of the disruption ofmortality trends caused by revisions of the ICD.

As shown below, there have now been eightrevisions of the ICD:

Revision of theInternational Classification

of Diseases

Year ofConference bywhich adopted

19001909192019291938194819551965

Years inuse in

United States

1900-19091910-19201921-19291930-19381939-19481949-19571958-1967

1968 to date

The search for a systematic method forevaluation of classification changes and otherchan~cs in the transition from one to the nextrevision of tl]c ICE) began with the introductionof the Second Revision, ad{jptcdLiscd C]uring 191 ()-2f). I)L]nn anr~their report on the comparability

2

in 1909 andShacklcy, inof mortal it}

statistics between the Fourth Revision (adopteclin 1929 and in use 193 O-38) and the Fifth Revi-sion (adopted in 1938 and in use 1939-48),included a definitive review of earlier attemptsto assess the effects on the comparability ofmortality statistics resulting from the intro-duction of a new revisional

Essentially, the approach in these earlierattempts was to compare the frequencies ofdeaths assigned to a given title of the newrevision for the first year it was in use with thefrequencies assigned to the most nearly com-parable title of the prior revision for the Iast .year it was in use.

Dunn and Shackley were the first to applythe dual-coding method. In their attempt tomeasure the 10SS of comparability with the dintroduction of the Fifth Revision, they firstclassified all certificates for deaths occurring in1940 by the Fifth Revision (in use 1939-48) andthen classified the same certificates by theFourth Revision (in use 1930-38). They pre-sented the results in two sets of figures: oneshowing the number of certificates assigned toeach cause by the Fifth Revision and the othershowing the number of certificates assigned bythe Fourth Revision. Instead of computing com-parability ratios, however, these authors com-puted percentages to show the extent to whichcomparability had been lost for each cause bythe introduction of the Fifth Revision.

The International Conference for the SixthDecennial Revision of the International Listsrecommended that deaths for a country as a .whole in the year 1949 or 1950 should be codeclaccording to both the Fifth and Sixth Revisions.In the Unitecl States 1950 was selected as thetransition year. The first set of comparability 4ratios, based on coding the same deathsoccurring in 1950 by both the Fifth and SixthRevisions, was published by the VitaI StatisticsDivision of the National Center for EIealth Sta-tistics (NCHS) in 1964.2 The second set of com -parabil~ty rat;os measured the effects of changesbetween the Sixth and Seventh Revisions.

The ratios in the present report, computodto measure breaks in comparability of cam.c-of-dcath statistics resulting from the introduct ionof the Eighth Revision, make only the thir(l setof ratios for tile United States.

The Sixth Revision represented a moresweeping change than any of the previous revi-sions. As stated by Faust and 1301man,3 up untilthe Sixth Revision (in use 1949-57)

. . . selection of a cause of death for tabula-tion was made by reference to a set of prior-ity tables published in the Aianual of]ointCauses of Deat/z. This manuaI, which wasdeveloped for use in the United States, wasfoHowed until 1949, when an internationalpro ce dure for joint-cause selection wasadopted. The Manual of Joint Causes ofDeath consists of priority tables based cm aseries of decisions made by clinicians re-garding the relative importance of variousdiseases as causes of death. By using thesepriority tables when more than one causewas jointly reported, the primary cause fortabulation was selected. The new interna-tional rules adopted for use in the UnitedStates in 1949 made the medical practitionerresponsible for indicating the underlyingcause of death. If the medical certification isproperly made, the physician’s statement ofthe underlying cause of death is accepted fortabulation.

In general the changes incorporated in theSeventh Revision (in use 1958-67) were oflimited scope and consisted of only essentialchanges and amendments of errors and incon-sistencics.4

The ICD has been made increasingly specificover these eight revisions. In the First Revisionthe categories and sub categories of diseases andinjuries numbered about 200; by 1939, whenthe Fifth Revision was put in use, the categoriesand subcategories numbered 425; and by 1968,when the Eighth Revision WM first used, theDetailed List consisted of 671 categories ofdiseases and morbid conditions pIus 182 cate-gories for classification of external causes ofinjuries and 187 categories for characterizationof injuries according to the nature of Icsion.

Meaning of Comparability Ratios

The comparability ratiosreport are basecl on codingoccurring in 1966 by both

prmentccl in thisthe sumc [Icathsthe Seventh aml

Eighth Revisions. More specifically, the clenom-inator of a ratio for any particular cause is thenumber of deaths in 1966 assigned to that causein accordance with the Seventh Revision, andthe numerator is the estimate of the number ofdeaths in 1966 assigned to the comparable causein accordance with the Eighth Revision. Theestimates of the deaths assigned by the EighthRevision are based on a random sample of alldeaths in 1966 stratified by cause (appendixIV). The year 1966 was selected because it wasthe most recent year for which final mortalitystatistics according to the Seventh Revision wereavailable at the time of this study.

A comparability ratio of 1.00 indicates thatthe same number of deaths was assigned to aparticular cause or combination of causeswhether the Seventh or Eighth Revision wasused. A ratio showing perfect correspondence(1.00) between the two revisions does notnecessarily indicate that the cause was unaf-fected by changes in classification and codingprocedures because the changes may compensatefor each other.

A ratio of less than 1.00 resz.dts from one oftwo situations: ( 1) a decrease in assignments ofdeaths to a cause in the Eighth Revision as com-pared to the Seventh, resulting, for example,from the transfer of inclusion terms, or (2) thecause as described by the Eighth Revision is onlya part of the Seventh Revision title with which itIs compared.

USUdly a ratio of more than 1.00 resultsfrom an increase in assignments of deaths to acause in the Eighth Revision as compared withthe compartiblc Seventh Revision cause. Attimes, however, the increase may result from thefact that the Eighth Re\~ision cause is not theequivalent of that described by the SeventhRevision title Jvith which it is compared. Forexample, consider the foIlowing division of theEighth Revision group title Diseases of arteries,arterioles, an~l capiHaries (440-448): Arterio-sclerosis (440) and Other clisewcs of arteries,artcriol~x, iin(l capillaries (44 1-448). A ratio of1.549 is obtainccl bv comparing the Sroup title

three titles in theancurysrn, notl -

aneu]?sm (45 1);

3

Seventh Revision Eighth Revision

Eighth Revision titleCategory

NumberCetegory

Estimatedof

numbarnumber

deathsnumber

of deaths

Total ..... .. .. .... .. . .. ... .... .. .. .. ... ... . .... . .. .. . ... ... .. .. ... . .. ... .. . . . . 15,213 . . . 23,567

Othar diseases of arteries, arterioles, andcapillaries ... . ... .... .. .. .... . ... .. ... . .... .. . ..... ... ... . ... . .... ... .. . ... .. . 451-456 15,213 441448 123,567

Aortic anaurysm (nonsyphilitic) .. .. ... ... . .. .. . ... .... . .. .... . 451 11,270 441 12,186

Gangrene ... .... .... .. .... ... ..... .. .. .. .. .. ... .. . .... ... ... . .. ... .. . .... .. 455 348 445 2,720

All other diseases of arteries, arterioles, andcapillaries ... .. ..... . .. ... .. . ...... . . ..... .. . ... .. .... .. . ... .. . .... .. .... . 452454,456 3,595 442444,446448 8,555 *

1The ~ubt~tals do not add “p e~a~]y to the total because of the application of different mmplisw fractions.

Gangrene of unspecified cause (455); and Otherarterhd diseases (452-454, 456). The estimatednumb er of deaths assigned to each of the three-digit subcategories in the Eighth Revision under441-448 together with the number of deathsassigned to each of the comparable three-digitsubcategories in the Seventh Revision are shownabove.

As this table shows, the comparability ratioof 1.549 (appendix I) results from an increasein assignments of deaths to each of the threesubcategories in the Eighth Revision as com-pared with the corresponding assignments in theSeventh Revision. About 86 percent of the1,434 deaths assigned in the Seventh Revision toAneurysm of aorta (022) under Syphilis and itssequelae (020-029) are assigned in the EighthRevision to Aortic aneurysm (nonsyphilitic)(441). Also, about 83 percent of the 2,342deaths assigned in the Seventh Revision to

GeneraI arteriosclerosis with mention “of gan- .grene as a consequence (450.1) are assigned inthe Eighth Revision to Arteriosclerotic gangrene(445.0). Finally, about 21 percent of the 10,078deaths assigned in the Seventh Revision toHernia and intestinal obstruction (560, 561,570) are transferred in the Eighth Revision toArteriaJ embolism and thrombosis of mesentericartery (444.2).

Use of Ratios as Revision Factors

The following table illustrates the applica-t io n of comparability ratios to determinewhether changes for two death rates were real orresulted from the adoption of the Eighth Revi-sion. The figures used are from the 10-percentsample for January-June 1967 and January-June1968. IrIeach instance the reported death rate in

.

column (3) was multiplied by the ratio in

4

Death rate per 100,000population: January-June

Eighth Revision title and category numbers Comparability1868:

1867: Seventh Revisionratio

EighthRevision Reported

Revised by ratio

incolumn (1)

(1) (2) (3) (4)

Hypertensive heert disease with or without ranaldisease .. ... .... . ... .... .. .. ... . .. .... .. . ..... .. . ... .. .. ... . .. ....4O2.4W 0.3841 9.7 26.6, 10.5

Active rheumatic fever and chronic rheumatic heartdisease .. .. .... . .. . .... .. . .. . .. .... ... .. . .... .. . ... ... . .. .. .. .... .390-398 1.1519 8.7 7.6 8.8

4

.

column (1) to obtain the death rate for for January-June 1968 shows a small decrease inJanuary-June 1967 that is most nearly com- the death rate for hypertensive heart diseasesparable to the death rate for January-June 1968. and no significant change in the death rate forA comparison of the revised death rates for the active rheumatic fever and chronic rheumaticearlier period with the corresponding death rates heart disease.

1. DISEASES OF HEART

All Diseases of Heart (ICDA Nos. 390-398,402,404,41 O-429)

As shown in the table below, the net effectof changes introduced with the Eighth Revisionon the number of deaths classified to Diseases ofheart, based on coding the abovedescribedsample of records for deaths occurring in 1966by both the Seventh and Eighth Revisions, wasan increase from 727,002 to 730,261. This givesa comparability ratio of 1.0045 (appendix I).

An estimated 10,711 deaths classified underthis title by the Eighth Revision were classifiedelsewhere by the Seventh Revision, and 7,452deaths classified under this title by the SeventhRevision were classified elsewhere by the Eighth.In other words, by the Eighth Revision therewas a gain to Diseases of heart of 10,711 deathsand a loss of 7,452 deaths, resulting in a net gainof 3,259 deaths.

The changes responsible for the largest lossesamong the estimated 7,452 deaths no longerassigned to Diseases of heart are presented belowunder the discussions relating to the major com-ponents of the diseases of heart for which thelosses occurred. The four major changes respon-sible for the largest gains among the estimated10,711 deaths now assigned to Diseases of heartcame from a number of Seventh Revision cate-gories and were distributed over the componentsof heart disease. These four major changes arepresented below.

(1) Among the 10,711 deaths assigned toDiseases of heart by the Eighth but not by theSeventh Revision were an estimated 1,773 thathad been assigned by the Seventh to accidentalcauses. Of these 1,773 deaths, an estimated1,422 were assigned by the Eighth Revision to

Ischemic heart disease (ICDA Nos. 410-413).These assignments occurred because the SeventhRevision rules that under certain circumstancesresulted in coding an accidental cause in prefer-ence to other reported conditions were changedin the Eighth Revision. These Seventh Revisionrules appIied when two or more conditions, oneof which was an accident, poisoning, or violence(but not a late effect of these), were entered onthe death certificate in such a way that nonecould be regarded as the underlying cause ofdeath.5 The Eighth Revision rules, however, leadto the selection of the first-mentioned conditionwhen causes of death are entered on the deathcertificate in this manner.6 The followingexample of entries in the medical certificationsection of a death certificate illustrates theeffect of this change in the coding rules. Thedeath described was classified to accidental fallby the Seventh Revision rules and to coronaryarteriosclerosis by the Eighth Revision rules.

I (a) Coronary arteriosclerosis(b) Fracture of hip due to(c) Accidental fall

(For further discussion on transfers by theEighth Revision from accidental causes, espe-cially falls, see section 4, “Accidents.”)

(2) Also among the 10,711 deaths assignedto Diseases of heart by the Eighth but not bythe Seventh Revision were an estimated 2,326that were assigned by the Seventh Revision toOther hypertensive disease (ICD Nos. 444-447).These transfers resulted from a change in theprocedure for coding causes of death involvingarteriosclerotic heart disease (without mentionof coronar~: artery disease) jointly reported with

5

Seventh Revision

Cause of death and category number

(1)

All causes .... .. . ..... . .. ... ... .. .. .. .. .. .... ... ... . .. . .. 001 -E999

Diseases of heart . . .. .... ... . .... . .. ... ... .. .....400402.41 O443Rheumatic fever .. .. .. . .... .... . .. .... .. . .... ... .. .. .. ... ...4 OO4O2Chronic rheumatic heart disease ..... .. . .... .. .. .. ..41 O4l6

Diseases of mitral valve . .. .. ... .. . .. .. ... . ... . ... . .. .... . ... . .410

Dkeasesof aortic valve specified as rheumatic .. ..4l 1Qiseases of pulmonary valve and otherendocarditis, specified as rheumatic .. ... . .....413.414

Other rheumatic heart diseasas...41 . .. .. ...4l 2,415,416Arteriosclerotic heart disease, including coronarydisease . . .. ... . .. ..... .. . .... .. .. ... ... . ..... . ... ... . .. .... . ...... .. ....42OArteriosclerotic heart disease so described ... .. ..42O.OHeart disease specified as involving coronaryarteries ... ... . . ..... . . .. .... .. . ... ... . .... ... .. ... . .. ... . . .. .. . ...42O.l

Angina pectoris without mention of coronarydisease .. . .... . .. .... . .. .... ... .. .... . . .. ... ... . ... .. . ... . .. ... . ...42O.2

Chronic endocarditis not specified as rheumatic...42l

Of Mitral valve, specified as nonrheumatic ... ...421.0Of aortic valve, not specified as rheumatic .. . ...421.1Of other valves, not specified asrheumatic .. .. .. .... .. .... ... ... ... . . .. ... .. . . .... .. ...42l .2421.4

Other myocardial degeneration .. .. .. .. .. . .. ... . . .... .. ....422With arteriosclerosis . .... .. ... . ... ... .... .. . ... .... .. . ... ...422.1Without mention of arteriosclerosis .. .. ...422 .t2.422.2

Other diseases of heart . .. .... .... ...... . . ..... . . .. . .. ...430434Acute and subacute endocarditis . .. .. ... . ... . . .. . .. . ....430Acute myocarditis and acute pericarditis, notspecified as rheumatic .. ... .. .. ..... .. .. .... .. .... . ...431.432Functional disease of heart . . .. .. .... .. .... ... .. .. . ... ... ...433

Other and unspecified diseases of heart .. .. . ... . .....434Hypertensive heart disease . .. . .. ... ... . .. ... . . ... .. ....44O-443

Hypertensive heart disease with arteriolarnephrosclerosis . .. .. .. .... . . ..... . .. .. .. .. .. .... . . .. .. .. ... .. ....442

Other hypertensive heart disease ... ... . ...440.441.443

Other causes ... .. .. .... .. .. .... . . .... .... .. ... .. .. ... . .. .... .. . Residual

Number ofdeaths

in 1966

(2)

1,863,149—

727,002456

14,5565,7181,713

7736,352

573,191158,802

414,101

288

3,785166

2,311

1,30849,79641,935

7,861

31,042757

1,06510,00819,21254,176

11,60642,570

1,136,147

Eighth Revision

Estimated number ofdeaths in column (2)

that went toDiseases of heart

(ICDA NOS. 390-398,402,404,410429 )

(3)

730,261.—— . . ... .. .

719,550449

14,4365,6661,693

7736,304

570,220158,012

411,920

1288

3,560157

2,261

1,14249,17541,464

7,711

28,277706

1,0517,693

18,82753,433

11,34542,088

10,711


that went toother causes

(4)

1,132,888—— —.- .— .-— .—. - .. ... . . . ---

7,4527,

120 ~52

20

48

2,971790

2,181

1-

2259

50

166621471150

2,76551

142,315

385743

261482

I1,125,436

lThere were “o deaths in the S.ampIe assigned to the Seventh Revision title Angina PectnrisWit]mutrrrmtimof c-nary disease

(ICD No. 420.2). NCHS nosologists state, however, that with a possible few exceptions these deaths Jvorsld be assigned by the EighthRevision to Angina pectoris (lCDA No. 4 13). The exceptions, if’ any, resulted from the dropping of the preference in the SeventhRevision of angina pectoris over cardiovascular diseases.

hypertensive disease. The Seventh Revision had classified to the appropriate hypertensive diseaseno special provision for classifying this com- category. In the Eighth Revision arterioscleroticbination of cliseases, and under certain circum- heart disease is classified as an ischemic heartstances the hypertensive disease was coded as disease, and four-clisit subdivisions have beenthe cause of death. For example, reports of ~rovidcd under the ischemic heart clisease cate-arteriosclerotic heart disease (ICD No: 420.0) ~ories for jointly

due to a condition classifial)lc to 1(211 Nos. (3) A third444-447 (C)ther hypertensive disease) were (Ieaths assigned

6

reported hypertensive disease.group among these 10,711by the Eighth Revision tc)

“

Diseases of heart incIuded an estimated 1,743that were classified by the Seventh Revision toVascular lesions affecting central nervous system(ICD Nos. 330-334). The largest number ofthese 1,743 causes, an estimated 1,249, wereassigned to Chronic ischemic heart disease(ICDA No. 41 2). In addition, an estimated 166were assigned to Hypertensive heart disease(ICDA No. 402), 164 to Acute myocardialinfarction (ICDA No. 41 O), and 82 to Sympto-matic heart disease (ICDA No. 427).

The assignments to ICllA No. 412, Chronicischemic heart disease, resulted primariIy from a

. change in the procedure for coding arterio-sclerotic heart disease, hypertension, and anintracranial vascular lesion when jointly reportedas causes of’ death. As mentioned above, nospecicd provision was made in the Seventh Revi-.sion for coding Arteriosclerotic heart disease(ICD No. 420.0) jointly reported with hyper-tension, but provision was made for codinghypertension jointIy reported with an intra-cranial vascular lesion to the intracranial vascularlesion. In the Eighth Revision provision is madefor coding hypertension jointly reported witharteriosclerotic heart disease as well as withintracranial vascuIar lesions. The result of thischange in coding procedure is that some deathsthat were attributed to intracranial vascularlesions by the Seventh Revision are classified tochronic ischernic heart disease with hypertensionby the Eighth Revision.

Two examples of entries in the medical cer-tification part of the death certificates thatillustrate this change in assignment are given+beIow:

I (a) Arteriosclerotic heart disease andcerebral hemorrhage

& (b) Hypertension(c)

I (a) Cerebral embolism(h) Arteriosclerotic heart disease(c) Hypertension

By the Seventh Revision both of the deathsreportc{i above would have been assi,gned tointracranial vascular lesions, but by the EighthRevision, alley are assigned to Chronic ischemicheart disease.

(4) Another substantial group among the10,711 deaths assigned by the Eighth Revisionto Diseases clf heart is an estimated 1,242 causesthat were coded by the Seventh Revision toGeneral arteriosclerosis (ICD No. 450). Almostzdl of these (1,209) were transferred to Chronicischemic heart disease (ICDA No. 412). In theEighth Revision provision is made for codingarteriosclerotic heart disease (which k classifiedto ICDA No. 412) in preference to arterioscle-rosis when the two conditions are jointly re-ported on the death certificate. According to theprovisions of the Seventh Revision preferencewas given to arteriosclerotic heart disease onlywhen this condition was specified as due toarteriosclerosis. Therefore causes of death certi-fied in the foIIowing manner are classified toChronic ischemic heart disease (412) by theEighth Revision and to General arteriosclerosis(450) by the Seventh Revision.

I (a) Hypostatic pneumonia(b) General arteriosclerosis with arterio-

(C)

Althoughentire group1.000, some

scleroticheart disease

the comparability ratio for theof Diseases of heart is cIose tomajor components of this group

have comparability ratios that differ substan-tially from 1.000. Factors pertinent to the ratiosshown in the table in appendix I for the fivemajor components of diseases of heart are pre-sented in the foIlowing paragraphs.

Major Components of Diseases of Heart

Active rheumatic fever and chronic rheu-matic heart disease (ICDA Nos. 390-398). –Inthe Seventh Revision diseases of the aortic valvenot qualified as rheumatic were included in ICDNo. 421.1, Chronic endocarditis of aortic vaIve,not specified. as rheumatic. This category wasnot included under the heading Chronic rheu-matic heart disease (ICD Nos. 410-416). In theEighth Revision, however, aortic vaIve cliseascs,unless specified as nonrheumatic, are includeduncler Chronic rheumatic heart disease (ICDANos. 393-398). As a result of this change in clas-sification aImost all of the c!eaths that were

7

Seventh Revision


(1)

All causes . .. .. .. ... ... ... .. .. ... .. . .... . .. ... ... . .. . .. .. 001. E999

Comparable causes . .. ..... .. . .... ...400-402.410416.421 .1Rheumatic fever and chronic rheumatic heartdiseasel . ... .. .... . .... .... ... .. .. ..... . .. .. .. ... .400AI02,41OAI16Rheumatic fever .. ... . ... ... . ... . ... ... ... . .. .. . ... .. . ....4 OO4O2

Chronic rheumatic heart disease ...410416... .. ....41 O4l6Diseases of mitral valve ... .. . .. . .. .. . .... . .. .. .. .. ... . .. ... .410

Diseases of aortic valve specified as rheumatic..4l 1Diseases of pulmonary valve and otherendocarditis, specified as rheumatic .... .....413.414

Other rheumatic heart diseases .... . .. .. ..4l 2,415,416

Chronic endocarditis of aortic valve, not specifiedas rheumatic ... .. .. .... .. .. .. .. .. .... . . ..... . .. .. . .. ... . .. .. ...42l .1

Other causes . .. .. . ... .. . .... .. . .... .. .. .... . . ... .. .. ... . .. ... . . Residual

Number ofdeaths

in 1966

(2)

1,863,149

17,323

15,012456

14,5565,7181,713

773

6,352

2,311

I

1,845,826

Eighth Revision

Estimated number ofdeaths in column (2)that went to Activerheumatic fever andchronic rheumatic

heart disease (ICDANOS. 390-398)

(3)

17,293

16,652

14,724443

14,2565,6001,686

7596,236

1,928



(4)

1,845,856

671

288

2;:.

11827

14116 .

383

641 I 1,845,1851This is the tit]e to ~hi~h deaths in taljes I and 2 were assigned during 1950-67, when the Sixth and Seventh Revisions were in use.

assigned to category 421.1 by the Seventh Revi-sion were classified under chronic rheumaticheart disease by the Eighth. This changeaccounts in great part for the fact that a largernumber of deaths (an estimated 1‘7,293) wereclassified by the Eighth Revision to Active rheu-matic fever and chronic rheumatic heart disease(ICDA Nos. 390-398) than were classifier-1 by theSeventh Revision (only 15,012 deaths) to thesimihir title Rheumatic fever and chronic rheu-matic heart disease (ICD Nos. 400-402,410-41 6). This gives an adjustment factor of1.1519 for these two titles. (See appendix I.)

As shown above, 1,928 of the 2,311 deathsassigned by the Seventh Revision to ICD No.421,1 were classified by the Eighth Revision toICDA NOS. 390-398.

During the period 1950-67 the death rate forRheumatic fever and chronic rheumatic heartdisease (ICD Nos. 400-402, 410-416) declinedfrom 14.8 to 7.2 deaths per 100,000 population.The appm-c]lt rise in the clcath rate for thesemuses in 1’368 to 8.2 per 100,000 population isattributable in great part to the al)ovc-

mentioned classification change. Applying thecomparability ratio 1.1519 to the 1967 deathrate of 7.2 raises it to 8.3 deaths per 100,000population, which is very close to the 1968 rateof 8.2. The downward trend continued through1971, when the rate was 7.1 per 100,000 popu-lation.

Hypertensive heart disease with or withoutrem-d disease (ICDA Nos. 402, 404). —The com-parability ratio for Hypertensive heart disease +with or without renal disease (ICDA Nos. 402,404) is only 0.3941. This ratio is obtained bydividing 21,350, the estimated number of 1966 &deaths classified by the Eighth Revision to thisgroup of causes, by 54,176, the number clas-sified to the most nearly comparable SeventhRevision title, Hypertensive heart disease (ICDNos. 440-443). (See appendix I.) The followingtable shows the results of coding a randomsample of 2,389 of these 54,176 dea;hs.

‘“.4s33,741by the(Iiscasc

shown in the table below, an estimatedof the 1966 deaths that were classifiedSeventh Revision to Hype’rtcnsive heart(ICD Nos. 440-443) \vcrc not classific(l

8

Eighth Revision

EstimatedCause of death and category number number

of deaths

Total .. ... ... .... ... ... !54,176

Hypertensive heart disease with or withoutrenal disease: 402 .. .. ... .. . ... .. .. .. . 10,717

404 .. . .... . .. ... . .. . .. . 9,718412.0 .... . . .... .. . .... 32,636Other .. .. . . .... .... . .. 1,105

Hypertensive disease: Total .. ... .. . .... ... ... 42,570

402 .. . . .... . . .. . .. .. ... 10,717.404 ... . ... .. .... .. .. ... 46412.0 .... ... ... .. ... . . 31,050Other .. .. . .. .... ... .. . 757

Hypertensive heart and renal disease: Total .. .... ... .. .. .. ... 11,606

.402 .. . .... . . .... . ... ... ..

404 .. .. .... . ..... ... ... 9,672

Chronic ischemic heart disease withhypertensive disease .. .... . . .. .. ... . .... .. . .... . . ... ... .. ... . ....41 2.0 ... ... . .. .. ... .. . 1,587

Other Eighth Revision titles . .. .. ... ... . . ... .. . .... .. .. .... .. . .. Other .... . .. ... .. .. .. . 347

Seventh Revision

Category Numbernumber of deaths

440-443 54,176

T442 11,606

f

to the most nearIy comparable Eighth Revisiontitle, Hypertensive heart disease with or withoutrenal disease (ICDA Nos. 402, 404). Of these,about 97 percent (32,636 of the 33,741) wereclassified to Chronic ischemic heart disease withhypertensive disease (ICDA No. 412.0) by theEighth Revision.

As shown in the next table, there were a totalof 42,570 deaths assigned to Other hypertensive

. heart disease (ICD Nos. 440, 441, 443) in 1966when the Seventh Revision was in use. In thedual-coding study, it was found that about 75percent of these deaths (31,807) were not

+ assigned to Hypertensive heart disease with orwithout renal disease (ICDA Nos. 402, 404) bythe Eighth Revision. Of the 31,807 deaths, anestimated 31,050 were classified to Chronicischcmic heart disease with hypertensive disease(ICDA No. 412.0).

The table below also shows that a total of11,606 deaths in 1966 were assigned to Hyper-tensive heart disease with arteriolar nephro-sclerosis (ICD No. 442) by the Seventh Revision.In the dual-coding study it was found that about17 percent of these deaths (1,934) were not

assigned to the Eighth Revision title Hyper-tensive heart disease with or without renaldisease (ICD.% Nos. 402, 404). Again, an esti-mated 1,587 of these 1,934 deaths were classi-fied to Chronic ischemic heart disease withhypertensive disease (ICDA No. 4 12.0).

These cliff erences in code assignmentsbetween the Seventh and Eighth Revisionsresulted pnmariIy from the two changes in clas-sification that are described below.

One of the two changes is for .4rtcrioscle-rotic h cart disease jointly reported with hypcr-tenszle disease. The Seventh Revision had nospeciaJ provision for classifying Arterioscleroticheart disease so described (ICD No. 420.0)jointIy reported with hypertensive disease. Con-sequently, some deaths attributable to this com-bination of diseases were classified b! theSeventh Revision to Hypertensive heart disease(ICD Nos. 440-443). In the Eight!~ Revisionarteriosclerotic heart disease is classified as anischemic heart disease, and four-digit sub-divisions arc provided under the ischemic heartdisease categ&ies for jointly reportedsive disease. As a result of this change

hyperten-in classifi-

9

Seventh Revision

Number ofCause of death and category number deaths

in 1966

(1) (2)

I

Eighth Revision


that went to Estimated number ofHypertensive heart deaths in column (2)

disease with or that went towithout renal other causes

disease (ICDA Nos.402,404)

(3) (4)

All causes .. .. .. .. .... .. .. .. .. .. .... ... . .. .. . ... .. ..... ..OOl .E999 1,863,149 21,350 1,841,799

Hypertensive heart disease . .. .. ... ... .... . . .. .. . .. ... .. ..44O-443 54,176 20,435Hypertensive heart disease with arteriolar

33,741

nephrosclerosis ... ... .. .. .. .. .. .. .. .... . .. ... .. .. .. . ... .. . ... .. ....442 11,606 9,672.

Other hypertensive heart disease ... . .. . .....440.441.4431,934

42,570 10,763 31,807

Other causes ... ... ... . ... .. . .... .. . ... .. ... ... ... ... . . .. . .. .... Residual 1,808,973 915 1,808,058

cation, the following examples of cause-of-deathcertifications were classified to a hypertensiveheart disease (specifically to ICD No. 443) bythe Seventh Revision and to Chronic ischemicheart disease with hypertensive disease ‘(ICDANo. 41 2.0) by the Eigh_th Revision: “

I (a)(b)

I (a)(b)

Arteriosclerotic heart diseaseHypertensive heart disease

Hypertensive and arterio-sclerotic heart disease

The second change is for Otl~er myocardiaidegeneration with arteriosclerosis, jointly re-ported with hypertensive disease. In the SeventhRevision category 422.1, Other myocardialdegeneration with arteriosclerosis, included theconditions listed below, and provision was madefor coding any condition in this category jointlyreported with a hypertensive disease (ICD Nos.440-447) to IIypertensive hem-t disease(440-443).

CilrdiosclcmsisC;irtiio\’:lsc\]lar:

~Wcriosclcr{jsis(Icgcncration(Iiscase

.

Cardiovascular sclerosisMyocardial degeneration with

arteriosclerosis orsynonym in ICD category 450

In the Eighth Revision the above-listed condi-tions are included in ICDA category 412,Chronic ischemic heart disease, and provision ismade for classifying a jointly reported hyperten-sive disease in a four-digit subdivision of thiscategory, 412.0. Specific examples illustratingthe effect of this change in classification aregiven below.

I (a) Cardiovascular

(b) Hypertension

disease [7th, ICD No. 422.1;8th, ICDA No. 412.9]

[7th, ICD No. 444;

.

8th, ICDA No. 401]

A

As statcrl above, the Seventh Revision provicicdfor the classification of cases such as this tohypertensive heart disease (ICD No. 443), whichincludes cardiovascular disease (ICD hTo. 422.1)jointly rcportcci with hypertension (ICI) No.444). In the Eighth Revision this example isclass ificfl to catc~ory 412.0, ClIronic ischc-micIIcart disease wit]] hypertensive (iiscasc, wilicil

i ncl Il(ivs car(iiovascul;lr disl’ttsc uncill:iiific(i

(lCI),I X(). 41 2.9) jointly wpurtc(i with hyper-tension (lC1)A N,(). 401).

10

.

.

I (a) ~ycscardial Ciegeneration [7th, ICD No. 422.2;8th, ICDA No. 428]

(b) Arteriosclerosis [~;~ X:L.JRo4~0 ~1, . .

11 NephroscIerosis [7th, ICD No. 446;8th, ICDA No. 403]

In the Seventh Revision arteriosclerosis (ICDNo. 450) with myocardial degeneration (ICDNo. 422.2) was classified to 422.1, Othermyocardial degeneration with arteriosclerosis.The above example was assigned by the SeventhRevision, however, to category 442, i-lyperten-sive heart disease with arteriolar nephrosclerosis,with includes conditions classifiable to category422.1 jointly reported with nephrosclerosis. Inthe Eighth Revision, arteriosclerosis (ICDA No.440) with myocardiaI degeneration (ICDA No.428) is ckified to 412.9, Chronic ischemicheart disease without mention of hypertensivedisease. This example, however, is assigned tocat egor y 412.0, which includes conditionsclassifiable to 412.9 jointly reported withnephrosclerosis.

During 1958-67 the death rate for Hyperten-sive heart disease (ICD Nos. 440-443) declinedfrom 42.7 to 25.3 deaths per 100,000 popula-tion. Applying the comparability ratio of 0.3941to the 1967 death rate of 25.3 lowers it to 10.0.This adjusted rate is close to the 1968 rate of8.8 deaths per 100,000 population. The down-ward trend for this cause continued through1971, for which year the rate was 6.8 deaths per100,000 population.

Ischemic heart disease (iCDA Nos.410-413).-~he most nearly comparable title forthis group of diseases in the Seventh Revision isArteriosclerotic heart disease, including coro-nary disease (ICD No. 420) (table B). Based onthe 1966 comparability study, an estimated14.57 percent more deaths (totaling 83,500)were assigned by the Eighth Revision to this titlethan were assigned to Arteriosclerotic heartdisease, including coronary disease (ICD No.420) by the Seventh Revision (appendix I). Asshown in the table, page 12, the largest singlegroup of these 83,500 deaths (an estimated41,228) were assigned by the Seventh Revisionto Other myocardial degeneration with arterio-

Table B. Esthated number of deaths in 1966 assigned to specified category numbers

$ &cified ~eventh Revkcm category numbers for provisional set ofcomparabilityICDA accordin to the Ei hth Revision: based on a stratified random sample drawnroln

ratios

[Somefiguresin this table differ slightly from those in other tables because they are based on a prehrninary sample that was smallerin size]

Seventh RevisionICD numbers

Total-------------

420.0-------------------420.1-------------------420.2-------------------422.1-------------------430-434-----------------440-443-----------------442-------------------440, 441, 443---------

“44:;;47------------------------------------

444, 445, 447---------

All other---------------

Total

687,083

157,748411,678

41,22;4,09553,65711,45442,20310,9596,6204,338

7,717

ioo,401

3,238

18;

18;2,857

2,85;

197

Eighth Revision ICDA numbers

402-404

27,443

20,5;;9,78010,7636>1895,705484

684

410

366,951

3,160360,794

23;1,090

69

6;46

::

1,556

411

6,888

6,78;

53

50

412

282,309

154,58843,857

40,99;2,92532,8611,67431,1871,867899968

5,218

413

25%

24;

12

11

Seventh Revision


(1)—..

All C~USi2S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001-E999

Comparable causes .. ... .. .... . ... ...420.422.1 ,440,441,443Arteriosclerotic heart disease, including coronarydiseasel . .. . .... . . ... .. .. .. .. .. . .... . .. .. .. .. .. .. . ... . .. ... . .. .. .. ... ..420Arteriosclerotic heart disease so c:escribed ..... ..42O.OHeart disease specified as invo!ving coronaryarteries .. .. . . .. .. .. .. ... .. .... .. . .. ... . .. .... . . ... .. . .. .. . .. .. . ...42O.l

Angina pectoris without mention of coronarydisease ... ... .. .. ... . .. .... . .. ... . .. ... .. . .. .. .. .. .. .. .. . .. .... . .. .420.2

Other myocardial degeneration witharteriosclerosis .. ... . .. .. .. .. .. .. .. .. ... .... . . .... . .. .. . . . .. .. ..422.1

Other hypertensive haart disease ... .. .... ...440.441.443

Other causes .... . .. ... . .. ... . .... . . .. .. .. .... . . ... . . ... .. . .. ... Residual

Number ofdeaths

in 1866

(2)

1.863.149

657,696

573,191158,802

414,101

288

41s35

42,570

1,205,453

—.—.———— .Eighth Revision


that went toIschemic heart

disease ( ICDA Nos.410413)

(3)——- .—

656.691

642,199

569,715157,749

411,678

2288

41,228

31,256

14,492


that went to

other causes

(4)

1,206,458

15,497

3,4761,053

2,423

2

707

11,314

1,190,961

1Thi$ is the title to ~hj~h deaths jn tables I and 2 were assigned during 1950-67, when the Sixth and Seventh ~evi~ionsWerein ‘se.2There ~veie no deaths in the asrnple~ssigrredto the Seve~th Revision title Angina pectoris without 11’SWItiOIS Of COronarY disease

(ICD No. 420.2). NCHS nosologists state, however, that with a possible few exceptions these deaths would be assigned by the EighthRevision to Angina pectoris (ICDA No. 413). The exceptions, if any, resulted from the dropping of the preference in the SeventhRevision of angina pectoris over cardiovascular diseases.

sclerosis (ICD No. 422.1), and of these 41,228deaths an estimated 40,993 were ck.ssified bythe Eighth Revision to Chronic ischemic heartdisease (ICDA No. 412). Among the terms clas-si fied by the Eighth Revision to Chronicis~hemic heart disease (ICDA No. 412) that wereincluded under Other myocardial degenerationwith arteriosclerosis (ICD No. 422.1) in theSeventh Revision are the following:

Cardiovascular:arteriosclerosisdegenerationdiseasesclerosis

Questions have been “raisecl about theappropriateness of including cardiovasculardiseases in category 412, Chronic ischemic heartclisease, sincecw-diovmcularn;wy arteries.

-,this classification impiics that

cliscase means disease of the coro-A study conducted several years

ago of death certificates reporting “cardio-vascular disease” indicated that this frequently isnot the case. In anticipation of a possible changein the classification of these terms and for thebenefit of those interested in doing furtherstudy, NCHS has created speciaI four-digit sub-categories under category 412 that are useclinstead of those listed under category 412 in theEighth Revision, ICDA (tabIe 3). These specialfour-digit subcategories permit the separation ofdeaths due to cardiovascular cliseme withoutevidence of a disease of the coronary arteriesfrom those due to other conditions classifiableto chronic ischcmic heart disease with or with-out mention of cardiovascular disease. Tl~ey areshown in the table below.

As shown below, of the 303,362 deaths in1969 assigned to Chronic ischemic heart disease,a total of 235,807 were dcscribeci in terms thatled to their nssi~nment to n~lnlbcrs 412.1 am{412.3. Tllc remaining 67,555 deaths were de-scribed in termscarciiovascul:ir

that led It) their tissi~llmcnt todisease witllo~lt mention of

.

.

12

,

Causa of death and Eighth Revision category number

Chronic ischemic heart disease .. .. .. .. .. . .... .. .. ... ...41 2

Chronic ischemic heart disease with or withoutcardiovascular disease with hypertensivediseese .... . .. .. ... . ... .. . .... . . ... . .. . .. .. .. . .... . .. .. .. . ... .. .. .....4l2.l

Cardiovascular disease without mention of chroniciachemic heart diseasa with hypertensivedisease ... . ... . .. . . .... .. . ... . .. ... . .. ... ... .. . ... .. .. .. ... ... .. .. .. ..4l2.2

Chronic ischemic heart disease with or withoutcardiovascular disease without mention ofhypertensive disease .. ... .. .. .... . . ... . ... . .. . ... .... .. .... ...41 2.3.

Cardiovascular disease without mention of chronicischemic heart disease without mention ofhypertensive disease .. .... . . ... . . .... . .... .. .. ... ... . . ... .. ...412.4

.

1969

Number ofdeaths

303,362

19,884

23,486

215,823

44,069

chronic ischemic heart disease, that is, tonumbers 412.2 and 412.4. (It should be notedthat subcategories 412.1 and 412.2 together areequivalent to ICDA category 412.0, and subcate-gories 412.3 and 412.4 together are equivalentto ICDA category 41 2.9.)

For 1969 the death certificates for only44,069 of these 67,555 deaths, however, did notmention hypertension. Because the SeventhRevision title Other myocardial degeneration(ICD No. 422) excluded conditions with men-tion of hypertensive disease, no more than these44,069 deaths may be assumed to have beentransferred from Other myocardial degenerationwith arteriosclerosis (ICD No. 422.1).

Also, as shown in the above table, the.percentage of deaths from Chronic ischcmicheart disease assigned to catego~ number 412.4increased from 14.5 for 1969 to 15.5 for 1971.Of deaths assigned to causes included in 412, the

●

percentage assigned to category number 412.4 isgreater for persons of races other than whitethan for white persons (table 3).

The 1966 comparability study also showedan estimated 31,256 deaths classified toIschemic heart disease (IC13A Nos. 410-4 13) bythe Eighth Revision that had been assi,gned toOther hypertensive heart disease (ICD Nos. 440,441, 443) by the Seventh Rcv’sicm. The vastma, jority of these (an estimated 31 050) wereclassified to Chronic ischernic heart tliscaw tt’ith

Pe:cent

100.0

6.6

7.7

71.2

14.5

1971

Number ofdeaths

312,351

19,832

22,610

221,404

48,505

Percent

100.0

6.3

7.2

70.9

15.5

hypertensive disease (ICDA No. 412.0). Aspreviously stated, these differences in ‘ codeassignments between the two revisions resuItedprimarily from changes in the classification ofdeaths involving arteriosclerotic heart diseasejointly reported with hypertensive heart diseaseand of those involving other myocardial degener-ation with arteriosclerosis jointly reported withhypertensive disease.

It was ako found that out of a total of10,008 deaths classified to Functional disease ofheart (ICD No. 433) by the Seventh Revision, anestimated 2,805 were assigned to Chronici schemic heart disease without mention ofhypertensive disease (ICDA No. 412.9) by theEighth Revision. These differences in codeassignments resulted pnmarily from a change inthe Seventh Revision procedure which gavepriority to Functional disease of heart (ICD No.433) over Other myocardiaJ degeneration witharteriosclerosis (ICD AIO. 422.1). In the EighthRevision functional heart diseases are includedin category 427, Symptomatic heart disease; andcategory 411!, Chronic ischemic heart disease,in c 1u des conditions classifiable to category422.1 in the se~~enth Revision. Also, a condition

classifiable tc category 412 is given priority overone classifiable to 427.

The distribution by the Eighth Revision ofthe 414,101 cleaths assigned by the SeventhI&ision to 1Ictirt disease specified as involving

13

Cause of death and Eighth Revisioncategory number

Ischemic heart disease . .. .. .. ... ... ... ..410=-$13With hypertensive disease (.0) .. .. .. . . .. . ...Without mention of hypertensivedisease (.9) .. .. . ... ... .. .. .. . ... . .. . .. . . .... .. .. .. .. ..

Acute myocardial infarction . ... .. .. .. .. ..41 OWith hypertensive disaase (.0) .. . .... .. ... . ..Without mantion of hypertensivedisease L9 ) .. .. . .. ... .. .. .... . . ... . . ... .. .. ... .. . .... .

Other acute or subacute forms of ischemic

heart disease . .... .. .. ... . .. .. . ... .. . ... .. .. .. ....4l 1

With hypertensive disease (.0) .. . .. ... .. .. ...Without mention of hypertensivedisease (.9} .. .... . .. ... .. .. .... .. ... . .. .. . .. . .... .. ...

Chronic ischemic haart disease ... .. .. ...412With hypertensive disease (.0) .... .. .... . .. ..

Withrwt mention of hypertensivedisease (.9) .. . ... .. . ... .. . .. ... .. . .... . . .... . .. ... . .. .

Angina pectoris ... .. .. .. . ... . ... .. . .... . .. .. . ...4l3With hypertensive disease (.0) .. .... . ... ... ..Without mention of hypertensivedisease (.91 .. .. ... .. .. . . ... . .. .. .. . .... . . .... .. .. .. .. .

Other causes . .. ... . .. . .... . . ... .. . ... . .. ... . Residual

Estimated deaths in1866 assigned toICD No. 420,1

411,678

37,073

374,605360,794

31,985

328,809

6,785485

6,30043,857

4,361

39,49612421242

2,423

lThis figure may he unreliable because there was OnlY one

sample death assigned to this cause.

coronary arteries (ICD No. 420.1), as found by

the 1966 comparability study, is shown above,About 88 percent of the 360,794 deathsassigned to Heart disease specified as involvingcoronary arteries (ICD No. 4.20.1) by theSeven t h Revision were assigned to Acutemyocardial infarction (ICDA No. 410) by theEighth. Since category 410 includes, however,deaths involving acute myocardial infarctionjointly reported with chronic ischemic heartdisease, the number of these deaths associatedwith chronic ischemic heart disease cannot beascertained.

Adjusting the 1967 death rate of 289.7deaths per 100,000 population for Arterio-sclerotic heart disease, includin: coronarydisease (ICD No. 420), to the level it would havebeen if the 1967 deaths had hccn cotlccf hy theEighth Revision raises it to 331.9 per 100,000(289.7 multip]icd by 1.1 457). This acljustcd rateis closer to the 1968 rate of 337.6 c!eaths pcr100,000 population” for lschcmic heart fiiscasc,wllicll is has<’(! on ct)(lill: deaths h} tllc lli:htl~Rcvisit)n. ‘1’hc 1971 death r;itc for this cailsc is327.() per 100,000 I](}pul:ltioll.

Chronic disease of endocardium and otherm y o ca rdial insufficiency (ICDA Nos. 4.24,428).–Figures for 1966 and 1967 are shown intables 1 and 2 for Seventh Revision. categories421, Chronic endocarditis not specified as rheu-matic, and 422, Other myocardizd degeneration,which appear to be comparable to the aboveICDA categories. As shown in appendix I and inthe table below, however, only about 16 percentof the deaths assigned to ICD categories 421 and422 by the Seventh Revision were assigned toICDA categories 424 and 428 by the Eighth.This occurred primarily because terms includedunder Other myocardial degeneration with ,7arteriosclerosis (ICD No. 422.1) were transferredby the Eighth Revision to Chronic ischemicheart disease (ICDA No. 412). The result wasthat an estimated 41,228 of the 41,935 deaths .that were assigned to ICD No. 422.1 by theSeventh Revision were assigned to Ischemicheart disease (ICDA Nos. 410-413) by theEighth Revision.

Another important factor was the changebetween the Seventh and Eighth Revisions in theclassification of diseases of the aortic valve. Asstated under the discussion of Active rheumaticfever and chronic rheumatic heart disease (ICDANos. 390-398), diseases of the aortic vaIve notspecified as rheumatic were included in category421.1 in the Seventh Revision. In the EighthRevision aortic valve diseases, urdess they arequalified as nonrheumatic, are included underChronic rheumatic heart disease. As a result ofthis change an estimated 1,922 deaths that wereassigned to ICD No. 421.1 by the Seventh Revi-sion were assigned to ICDA No. 395.9 by the

.

Eighth Revision.The 1967 death rate for Chronic enclo-

carditis not specified as rheumatic together with +Other myocardial degeneration (ICD Nos. 421and 422) was 26.6 per 100,000 population.Adjusting this rate to the level it WOUICIhavebeen if 1967 cleaths had been cocled by theEighth Revision reduces it to 4.8 pcr 100,000

(26.6 multiplied by 0.1823). This adjusted rateis CIOSC to the 1968 rate of 3.9 deaths pcr100,000 population,” bawd on cocling deaths l)>(I1c Eiqhth Revision. l’or 1971 the (Icath r;!tc forthis cilusc dropped to 3.0 pm 100,000 pf)p~d;l-ti{)n.

14

Seventh Revision


(1)

All CSUSS?S.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 -E999

Nonrheumatic chronic endocarditis and other

myocardial degeneration 1 .... . .. .. . .. ... .. . .. ... .. ....421 ,422

Comparable causes .. . . .... . ... ... . .. .. . . .....421 ,422.0,422.2Chronic endocarditis not specified asrhaumatic .... . ... . .. .. . .. ... . .. ... .. . ... . . ... .. .. .. .. .. .. .. .. .. .. ..42lOf mitral valve, specified as nonrheumatic ....421.0Of aortic valve, not specified as rheumatic ....421.1Of other valves, not specified as

. rheumatic ... ... . . .... . . .... . .. . .. .. .. . .. .. . .. .. . ....42l .2421.4Other myocerdial degeneration without mentionof arteriosclerosis .. .. ... .. . .... .. . .. . ... ... . .. ... .422.0,422.2

Other cauws ..... .. .. ... .. . .... . . ... .. .. ... . .. ... . .. .. .. .. ... ResidualOther myocerdial degeneration with arterio-*lerosis .. .. ... .... . . ... . .. .... .. . ... .. . ... . .. .. ... . .. .. .. ... .. . ..422.l

Number ofdeaths

in 1866

(2)

1,863,149

53,581

11,646

3,785166

2,311

1,308

7,861

1,851,503

41,935

Eighth Revision

Estimated number ofdeaths in column (2)that went to Chronic

disease of endocardiumand other myocardialinsufficiency (I CDA



NOS. 424, 428)

(3) I (4)

9,768 I 1,853,381

8,688

8,452

1,469129283

1,057

6,983

1,316

236

44,893

3,184

2,31637

2,028

251

878

1,850,187

41,699

1‘rh~ is the title to which deaths in tables 1 and 2 were assigned during 1950-67, when the Sixth and Seventh Revisions Were in ~.

All other forms of heart dzkease (ICDA Nos. 1)420-423, 425+/27, 429). –Introduction of the

Eighth Revision resulted in assigning about 19percent fewer deaths to this group title thanwere assigned to the most nearIy comparabletitle, O t her diseases of heart (ICD Nos.430-434), by the Seventh Revision. This gives a

* comparability ratio of 0.8104 (appendix I).

As shown in the tabIe below, an estimated5,664 of the 10,008 deaths that had beenassigned to Functional disease of heart (ICD No.

, 433 ) by the Seventh Revision were not assignedto All other forms of heart disease (ICDA Nos. 2)420-423, 425-427, 429) by the Eighth Revision.An estimated 2,805 of these 5,664 deaths wereclassified to Chronic ischemic heart disease with-out mention of hypertensive disease (ICDA N’o.412.9), an estimated 1,498 to Arteriosclerosis(ICDA No. 440), and an estimated 272 to Ccre-brovascular diseases (ICDA Nos. 430-438) bythe Eighth Revision. These differences in assign-ments resulted from the following changes incoding proccdl,res:

Functional heart disease jointly reportedwit il 0 ther myocardial ciegencrationwith arteriosclerosis. –In the SeventhRevision provision is made for codingFunctional disease of heart (IC13 No.433) in preference to Other myocarclialdegeneration with arteriosclerosis (ICI]No. 422. 1). In the Eighth Revision thiscombination of diseases is classified toChronic ischemic heart disease withoutmention of hypertensive disease.

Functional heart disease jointly report cdU,it]l art~rioscleros~. – The seventh Rcvi.

sion provides for the classification of thiscombination of diseases to functionalheart disease. In the Eighth Revision nospecial preference is given to functionalheart disease. ‘1’hcrcfore, uncler certaincircumstances assignment is to Arterio-sclerosis, e.g., when functional heartdisease is reported as duc toarteriosclerosis.

15

Seventh Revision


in 1966

(1) I (2)

All causes ... .. .. .. .. ... . .. .... .. .. .. .. . .... . . ... . . .. .. .. 001-E999 i 1,863,149

Other diseases of heart .. .. ... .. .. ... .. . ... . .. ... ... .. .. ...430-434 ~Acute and subacute endocarditis ... .. .... . . .... . .. .. . .. ...430 757Acute rnyocarditis and acute pericarditis, notspecified as rheumatic ... .... .. .. ... .. ... . .. ... . . ... ....431.432 1,065Functional disease of heart . ... .... . .... .. .... . .. ... .. . .. .. ...433 10,008Other and unpacified diseases of heart .. . ... .. .... . ...434 19,212

Other causes .. ..... . . .... . ... ... . .. ... .. .. .. .. ... ... .. .. .. .. . .. Residual I 1,832,107

Eighth Revision


that went to Allother forms of heartdisease (ICDA Nos.

420423,425427,429)

(3)

25,156

23,375654

8924,344

17,485

1,781



(4)

?,837,993

~,667103

1735,664 .

1,727

1,830,326

.

3) Functional heart disease iointly re~orted II Cerebrovascukr disease, . .with arteriosclerosis and cerebro vasculardisease. –In both the Seventh andEighth Revisions provision is made forcoding cerebrovascular diseases in pref-erence to arteriosclerosis. As notedabove, however, the provision for codingfunctional heart disease in preference toart e ri o sclerosis was dropped in theEighth Revision. As a result of thischange the foIIowing exampIes are clas-sified to cardiac arrhythmia by theSeventh Revision and cerebrovasculardisease by the Eighth Revision:

I (a) Cardiac arrhythmia(b) Arteriosclerosis(c)

I (a) Arrhythmia and cercbrovascuIardisease

(b) General arteriosclerosis(Cj

The adjusted 1967 death rate for Otherdiseases of heart (ICD Nos. 430-434) is 12.8deaths per 100,000 population. This is obtainedby multiplying the recorded death rate of 15.8by the comparability ratio of 0.8104. The deathrates for 1968-71 are 14.0, 15.0, 15.9, and 16.6,respectively, per 100,000 population.

,

. .

16

2. MALIGNANT

All Malignant Neopiasms (ICDA Nos. 140-209)

The introduction of the Eighth Revisionresulted in ,an estimated net increase of less than0.2 of 1 percent in the number of deathsassigned to this group of causes. Based on the

NEOPLASMS

Seventh Revision

sample of 1966 deaths coded by both theSeventh and Eighth Revisions, there were 2,342deaths assigned to categories under this title bythe Eighth Revision that were classified else-where by the Seventh. On the other hand, therewere 1,816 deaths assigned to this title (ICD


(1)

All CeUSJ3S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 -E999

8alected causes .. .... .. ... . .. .. .. ..l4O-2O5.284.295.297-299Malignant naoplasms, including neoplasms of lym-phatic and hematopoietic tissuesl ..... . .... . .. ...140-205Malignant neoplasm of buccal cavity andpharynx .. .... . .. ... . . ... . .. ... . ..... . .. .. . . ... .. . .. .. .... .... 140-148Of lip . . . ... .. .. ... .. .. ... . .. .. . . ... .. . .... . .. ... ... . .... . .. .... . . ....l 40Of tongue .. .. . ... . . .... . . .. . .. .... .... . . ... ..... . ..... . . ... .. ..... 141Of other and unspecified parts of buccalcavity .... .. . ..... . . ... . .. ... .. . ... . .. .. .. . ... .... . ... .. .. ... 142-144

Of pharynx . .... . . ... .. . ... . . ... .. .. ... . .. .... . .. ... .. .. ...l 45-148Malignant neoplasm of digestive organs and peritone-um, not specified assecondary...l 50-1 56A,157-159Of esophagus . . .... .. .. .... ..... . . .... .. .. .. . . ..... . .. .... .. .. ... .150Of stomach .. . .. ... . ... .. .. .. .. . . .... . .. .... .. .. ... .. .. .. .. .. .... . 151Of small intestine, including duodenum ... . .. .....152Of large intestine, except rectum .. .... .. . ... .. .. .... ..l 53

Cecum, appendix, and ascending colon ... ....153.0Transverse colon, including hepatic and splenicflexures .. .. .. .. ... . .. ... . .. .. .. . ... . .. ... ... . .. ... .. ... . .. ...153.1Descending colon .... ... . .. .... . .. ... . .. .... ... . ... .. . ...1 53.2Sigmoid colon .... .. . .. .. ... ... . .. . ... .. .. ... . ... ... .. .. ...1 53.3Multiple parts of large intestine .... .. .. .. ... .. . ...1 53.7Large intestine (including colon), pertunspecified .. ... . .. .. ... . .... .. .... .. ... . .. .... .. .. .... . . ...l 53.8

Intestinal tract, part unspecified .. ... . .... .. .. ....l 53.9Of rectum ... . .. .... .. . .. ... .... .. ... . .. . ... .. .. .. .. .. .. .. .. . ... .. . 154Of biliary passages and of liver (stated to beprimary site) .. . .. .. . .. . .. . ... . .. ... . . .. .. .. .. ... . .. .... .. .... ...l 55Liver ... .. .... . ... ... . .. .. . ... ... .. . . .. .. . ... . .. .... . .. ... . ... .. . 155.0Other and multiple sites of biliarypassages ... .. . ... . .. ... .. .. .... . .... .. . ... .. . ..... . .155.1,155.8

Of Iivar, not stated whether primary orseconds ry . . .. ... .. .. .. .. .. .. ... . .... . . .... .. . ... .. .. ... .. . ... . 156AOf pancreas .. .... .. .. .. .. .... .. .. .. . ... ... . .. .... .... . . .... .. .. .. 157Of peritoneum and of unspecified digestiveorgans . .. .... . ..... .. .. .. .. . ... .. . ... ... . .... . . .... . .. ... . ...158,159

Number ofdeaths

in 1968

(2)

1,863,149

305,013

303,736

6,800150

1,629

2,2242,797

95,0795,505

17,623

69332,811

4,605

1,4721,1515,814

78

18,1551,536

10,663

6,5842,112

4,472

3,14916,360

1,691

Eighth Revision


that went to Malignantneoplasms, including

neoplasms of lymphaticand hematopoietictissues (ICDA Nos.

140-209)

(3)

304,262

302,559

301,920

6,744143

1,614

2,2052,782

94,5595,461

17,623652

32,6164,568

1,3971,1515,814

78

18,1171,491

10,538

6,5432,112

4,431

3,14916,256

1,691



(4)

1,558,887

2,454

1;816

567

15

1915

52044

41195

37

75

3845

125

41

41

74

lThis is the title to which deaths in tables I and 2 were assigned during 1950-67, when the Sixth and Seventh Revisions were in we.

17

Continued from previous page.

Seventh Revision


(1)

Malignant neoplasm of respiratory system, notspecified as secondary .. ... . . ... .. .. .. .. . ... . ... .. ....1 60-164Of larynx ... .. ..... . . .. .. ... . .... . .. ... . . ..... .. .... .. .. .. . .. .... ..l 61Of bronchus and trachea, and of lung specified

as primary .. ... ... . ... .... . .. .... . ..... .. . .. .. . . .. .. .. .... . . .. ...l 62Of lung, unspecified as to whether primary or*con& ry .. .. .. . ..... .. .... . .. . ... ... .. . .. ... .. ... ... .. .. .. .... ..l63

Of other parts of respiratory system ..... .. ...l 60,164Malignant neoplasm of breast ..... .. . ... .. ..... . .. . .. . ....1 70

Malignant neoplasm of genital organs ... ... ....l 71-179Of cervix uteri ... ... ... ... . .. ... . .. ... . ... . ... . .... ... .... . ... ..l 71Of other and unspecified parts of uterus ...172-174Of ovary, fallopian tube, and broad ligament ...175Of other and unspecified female genitalorgans . .. . .... .. ... . .. .. .. .. .. .. . .. .... .. . ... .. ..... .. .. .. .. .. ... . ..l76

Of pro*te . .. ... .. . ..... . .. .. ... . ... .. . .... . .. .. ... . ... ... . ... ...l 77

Of all other and unspecified male genitalorgans .. . .. . ... .. .... .... .. .. . . ... . .. . .. . . ... .. . .. . .. .. .. ....l 78,179

Malignant neoplesm of urinary organs . .. .. . ...l8O.l8lOf kidney .. ... . .. .. .. . ... .. . ... .. . ... .. .. ... . ... . ... ... .... ... . ...180Of bladder and other urinary organs . .... . .. .. ... . ...l 81

Malignant neoplasm of other and unpacifiedsites ... .. .. . ... . .. .. .. . ... ... .. ... . ... ... .. .... 1568,165,’I 90-199Of skin .. ... .. . .... . . .... . .. . .. ... .. ... .. . . .. ... ... .. ..... . .. 180,191Of eye .. . . ... . . .... .. .... .. .. .. .. .. .... . . .... . . .... .. .. .. .. . .. .... ..l 92Of brain and other parts of nervous system ... ...193Of thyroid gland ..... ... .. ... .. ... .. . .... .. ... . .... .. .. . .. ... ..l 84Of bone . . ... .. . ... .. ..... .. . ... . .. . .... .. ... .. . ... .. . ...... .. . ... ..l96Of connective tissue .. . ..... .. .. . .. .... . .... .. .. . ... .. .. .....1 97Of other specified sites, not stated to besecondary .. . .. ... . ... ... .. .. ... .. . .... . ... .. .. ... .. .. ..195.1 99A

Of unspecified sites ... . . ... .. . .... . 156B, I 65,198,1998Leukemia and aleukemia ... . . ... .. . .... .. . . .. .. .. ... .. ... ...204Lymphosarcoma and other neoplasms of lymphaticand hematopoietic tissues . .. .... .. . ... ... . ...2OO-2O3.2O5Lymphosarcoma and reticulosarcoma ... . ... ... . ...200Hodgkin’s disease ............... ..............................201Othar neoplasms of lymphatic and hematopoietictissues . .. . .. ... ... . ... ... .... .. . .... . . .... ... . ... . .. ..2W.2O3.205

Other diseases of blood and blood-formingorgans ... . .... . .. .. .. . ..... .. . .... . .. .... ... .. ... . .294,295,297-299

Other muws .. .. .. .. . ... .. .. ..... . . .... . ... .. .. . ... .. .. .... .. .. Residual

Number ofdeaths

in 1886

(2)

64,9342,623

20,913

30,565

27,~340,378

7,6655,7319,163

86515,941

1,01314,166

5,8418,325

35,0324,560

3587,3551,0081,7921,318

1,42217,21914,012

15,8027,5633,412

4,827

1,277

1,558,136

Eighth Revision


that went to Malignantneoplesms, including

neoplasms of lymphaticand hematopoietictissues (ICDA Nos.

14&209)(3)

64,8412,623

20,891

30,519803

27.37740,175

7,6145,6979,145

85015,856

1,01314,073

5,8278,246

34,6674,545

3587,1521,0061,7921,318

1,40817,08613,926

15,5587,5483,388

4,612



(4)

93

22

46:!5

156

203513418

.

1585

.-931479

36515.-

203.-.-.-

14133 .86

–J!-l--- 1556?Nos. 140-205) hy the Seventh Revision that Seventh were al~oltt 639 deaths that were classi-

were classified ehxkhcre by the Ei~;hth. ficd under Otllcr cliscascs 0[ t)lot)d and hlo(xl.,

~~mc)n~ the 2,342 <ica(hs that Ivere :lssi{gnd formins organs (ICI) Nos. 294, 295, 297-299)to Alalignant IIeoplasmsj inclu(iing nct)plasms of I)y tllc Scvmth Revision. A change in the classi-lymphatic and 1~1’lll;it(]I>f)it:tic tissues, h}’ the fication of pol)”cythcnliil (vetu) from ICI) X().Liyj]th Rciisi[)[l hut to other catqprics hy the 294 in the !%vcnth Revision L() ICI)A N{). 208 in

18

the Eighth Revision accounted for most of thesedifferences in assignments.

Also included in the 2,342 figure were anadditional 382 deaths that were classified underDiseases of the blood and blood-forming organs(ICD Nos. 290-299) by the Seventh Revision.These differences in assignments were dueprimarily to the transfer of terms from Leuko-erythroblastic anemia (ICD No. 292.3) in theSeventh Revision to Myelofibrosis (ICDA No.209) in the Eighth Revision.

Major Components of Malignant Neoplasms.

Mali~ant neoplasms of buccal cavity andpharynx (ICDA Nos. 140-149).–There was a netincre&e of 405 deaths assigned to this group ofcauses by the Eighth Revision.

.Of the 567 deaths classified under the above

title by the Eighth Revision and under othertitles by the Seventh, the largest component wasassigned by the Seventh Revision to MaIitgnantneoplasm of unspecified sites (ICD Nos. 156B,165, 198, 199B). More specifically, it is esti-mated that 415 of these deaths were assigned bythe Seventh Revision to Malignant neoplasmwit h primary site not indicated (categorynumber 199B).

These differences in assignments resultedprimarily from a change in the procedure forclassifying malignant neoplasm of multiple siteswith no indication as to which was the primary

site. The ruIes in effect with the two revisionsare given below. It should be noted, ho};ever,that these rules do not apply to malignant neo-plasm of liver or lymph nodes without specifica-tion as primary jointly reportecl with anothersite. Under such circumstances the neoplasm ofIiver or lymph nodes is assumed to be secondary.

Seventh Revision.—”If there is no indicationas to which was the primary site (forexample, if sites are entered on the same lineor in a sequence which does not point to oneas the primary), assignment should be tomalignant neoplasm of multiple sites (199),except where the classification providesspecifically for mtdtiple sites within three-digit categories (140.8, 141.8, etc.).”s

Eighth Revision.-”If there is no indicationas to which was the primary site (forexample, if sites are entered on the same lineor in a sequence which does not point to oneas the primary), prefer a defined site to anill-defined site in category 195 and of two ormore defined sites prefer the first men-tioned.”6

The effect of this change in coding procedurecan be illustrated by the following example,which was ckssified to Malignant neopksm withprimary site not indicated (category number

Seventh Revision●


*

(1)

All causes ... .. .. .. ..... . .... . .. ... .. .... .. . ... . .. ... . . .. 001 -E999

Malignant neoplasm of buccal cavity andpharynx . ..... .. .. .. .. .. .. .... .. .. .. . .. .. .. .. .. .. . ... .. .. ... . . .... 140-148

Of iip .. ... .. .. . ... . . .. ... .. .. .. .. .. ... . ... . . .... . .. .... .. .... . ... .. .. ....l4OOf tongue .. .. .. . .. ... . . .. .. . .. ... . .. ... .. .. ... . . ... .. . .... . . ... . . .....l4lOf other and unspecified parts of buccalcavity ... ... . .... . .. .... . .. .. .. .. ... .. .. .. .. . .... . . ... . .. .. .. .. ..l42.l44

Of pharynx .... . .. .. .... .. .. .. . ... . .. ... .. . .... . .. ... ... .. .. . ..l45.l48

Other causes ..... .. .. .. . .. ... ... . .. ... ... .. . .... .. .. .. .. . ... .. . Residual

Number ofdeaths

in 1966

(2)—

1,863,149

6,800150

1,628

2,2242,797

1,856,349

Eighth Revision


that went to Malignantneoplasms of buccalcavity and pharynx

(ICDA NCIS. 140-149)(3)



(4)

7,205 ! 1,855,944

6,638126

1,603

2,1842,715

1622426

3082

567 I 1,855,782

19

Table C. Comparable category numbers for Malignant neoplasms of digestive organs andperitoneum according to the Eighth and Seventh Revisions and comparability ratios forthese causes of death: United States, 1966

Eighth Revisioncategory title

Malignant neoplasms of digestive organsand peritoneum- -------- -------------------

Of esophagus -----------------------------of stomach -------- ---,-------------- --------

Of small intestine, including duodenum---Of large intestine, except rectum --------Of rectum and rectosigmoid junction ------Of liver and intrahepatic bile ducts,specified as primary --------------------

Of gallbladder and bile ducts ------------Of pancreas ------------------------------Of peritoneum, retroperitoneal tissue,

EighthRevision

lCDA numbers

(1)

150-159

150151152153154

155156157

and unspecified dig-estive organs-------- 1 158,159

SeventhRevision

ICD numbers

(2)

150-156A,157-159

150151152153154

155.0155.1,155.8

157

158,159

—Compara-bilityratiol

(3) _

0.9660

0.99(:1.01650.9806

0.981!40.98601.001.9

0.8639 ‘

lRati,o of deaths assigned according to the Eighth Revi,si,on to deaths assigned ac-cording to the Seventh Revision.

199B),by the Seventh Revision and to Ma.Iig-nant neoplasm ofnasopharynx (ICDA NO. 147)by the Eighth Revision,

I (a) Carcinomaofnasopharynxandlmynx(b)(c)

Notes for use in primary mortality codingfor the Eighth Revision are shown in appendixVI.

Estimates based on 1968 data that are con-sistent with the estimated number of 1966deaths that were assigned by the Seventh Revi-sion to category number 199B and by theEighth Revision to ICI)A Nos. 140-149 arepresented in appendix VII.

Tile rise in the deathratef orhlaliawantneo-pkms of bucca] cavity and pharynx between1967 ancl 1968 from 3.4 to 3.6 deaths per100,000 population is attributable to the above-mcntioned change in coding procedure betweenthe Seventh and Eighth Revisions. Applying thecc]mparability ratio of 1.0596 to the 1967 deathrate for this ~vo[(p of c~tuses r~iism it to 3.6, theswnc m that for 1968. For 1969 t]lc rate Was 3.7(!cnths pcr 100,000 p(~pulation.

Mahjyaantneoplasms ofdigestive organs andperitoneum (ICDA Nos. 150-159).–The intro-duction of the Eighth Revision resulted in theassignment of about 3.4percent fewer deathstocategories under the above titIe than wereassigned to categories under the comparableSeventh Revision title. The compa.rability ratiosforthis~oupof causes and for the nine subcate-gories into which it has been divided are shownin tabIe C.

As shown in the tabIe below, an estimated4,415 of the 95,079 deaths that were assigned tothe comparable Seventh Revision title hldi~ant *neoplasm of digestive organs and peritoneum,not specified as secondary (ICD Nos. 150-156A,157-1 59), were not assigned to Malignantneoplasms of digestive organs and peritoneum(ICDA Nos. 150-159) by the Eighth Revision. “Conversely, an estimated 1,184 deaths assignedto this group by the Eighth Revision were classi-fied elsewhere by the Seventh.

Among the 4,415 deaths classified! by theSeventh Revision under illalignant neoplasm ofdigestive organs and peritoneum, not speci fiecl assecondary, but classified elsewhere by theEighth Revision were an estimated 3,149 deathsthat were assigned to category number 156A bythe Seventh Revision and to ICDA Nos. 194-199by the Eighth Revision (table D). h~ost of these

20

Seventh Revision

Cause of death and &atagory number

(1)

All WUSS ... . .. .. .. .. .. . ... . . .. .. . . ... .. .... . .. .. .. . ... . 001 -E988

Malignant neoplasm of digestive organs and peritoneum,not specified es secondary ............. 150-1 E6A,l 57-159Of eso~~us ........... ..m... ............................. ..........l 50Of stomach ............. ...... ........................................151Of small intaatina, including duodenum ...............152Of Ierge intestine, except rectum ................ ..........l 53

Cacum, eppendix, and ascending colon ...........153.0Transverse colon, including hepatic and splenicflexures ....................................... ...................l 53.1Descending colon ................................. ...... .....1 53.2Sigmoid colon .... ..... .................................. ......153.3Multiple parts of large intestine ............ ...........l 53.7Large intestina (including colon), part unspaci-tid ............... ...... .......... ..................................l 53.8Intestinal tract, part unspecified ......................l 53.9

Of rectum ................... .... ......................................154Of biliary passagesand of liver (stated tobe primary sits) ............. ........................ ..............155Liver............................. ...................................155.0Other and multiple sites of biliarypas*es ........................ ...... ..................l 55.1,155.8

Of liver not stated whether primary orsacondary2 .......... ...... ........... ............................ 158AOf pencrsas ............... ........... ................................157Of peritoneum and of unspecified digestiveorgans........................ ...................................158,158

Number ofdeaths

in 1856

(2)

1,s63,149

95,0795,505

17,623693

32,8114,605

1,4721,1515,814

78

18,1551,536

10,663

6,5642,112

4,472

3,14916,360

1,691

Othar causes.................4... .......................... .... RasidualI

1,768,070

Eighth Revision


that want to Malignantneoplasms of digestiveorgans and peritoneum(ICDA NOS.150-159)

(3)

91.s48

90,6645,461

17,547652

32,4184,484

1,3971,1515,774

76

18,0781,446

10,455

6,3982,00s

4,390

L16,248

1,485



(4)

1.771.301

4,415447641

393111

75

:0

z208

186104

82

3,149112

206

1,164I

1,766,866

l+h=e were no deatha in the Sampleamigned to the Seventh RevWon title Msdignant SI!?OphMm of muhipk parts of large inte$tine(lCD No. 153.7). NCHS nosologists state, however, that these deaths would be distributed by the Eighth RevMon over the fourdigit

. categories under Melignant neoplasm of large intestine, except rectum (ICDA No. 153).‘In computing a provisional comparability ratio (0.9991) for Malignant neoplasm of digestive organs and peritoneum (ICDA Nos.

1SO-159), the Seventh Revision title Malignant neoplasm of liver not stated whether primary or secondary (ICD No. 156A) was notincluded in the set of titles most nearly comparable to Malignant neoplasm of digestive organs and peritoneum. Category number 156Awas thus excluded because most deaths assigned to this category by the Seventh Revision were removed by the Ewhth Revision from

●under the title classifying the systemof the body attacked by the neoplasm(in this case, from under digestive organs and peritoneum)and placed under a subsection of section H, “NeopIasms”: Malignant neoplasm of other and unspecified sites (ICDA Nos. 190-1 99).More apeciflcally, these deaths were transferred to the new Eighth Revidon title: Malignant neoplasma of liver, unspecified (ICDA No.197.8).

differences in assignments were due to the digit categories of ICDA Nos. 194-199. Thistransfer of malignant. neoplasm of Iiver, not distribution shows that the 2,981 deathsstated whether primary or secondary, from cate- assigned to ICDA No. 197.8 constituted 14.35gory number 156A in the Seventh Revision to percent of the total number (20,768 deaths)ICDA No. 197.8 in the Eighth. A satisfactory assigned to ICDA Nos. 194-199. It may beindication of how many of the 3,149 deaths postulated, therefore, that approximately 14.35were assigned to ICDA No. 197.8 and how many percent (or 2,808 deaths) of the estimatedwere assigned to ICDA Nos. 194-199 other than 19,570 deaths in 1966 assigned by the Eighth197.8 may be obtained from the distribution of Revision todeaths occurring in 1968 in the three- and four- 197.8. The

ICDA Nos. 194-199 were assigned todifference between 3,149 and 2,808

21

Table D. Number of deatha in 1966 coded by the Seventh Revision to each title in which mslignant neoplasm ofliver, intrahepatic bile ducts, gallbladder , or extrahepatic bile ducts ia included in the title, whether thetitle was for neoplasm specified as primary or secondary or was unqualified, distributed by the titles to whichassigned by the Eighth Revision,and number of deatha in 1966 and 1968 assigned to these Eighth Revision titles:United States

——

Seventh Revision

Cause of death

All causes----------

Specified causes--------

Malignant neoplasm ofbiliary passages andof liver (stated tobe primary site)-----

Liver---------------

Gallbladder andextrahepatic gallducts, includingsmpulla of Vater--:

Multiple sites------

Malignant neoplasm ofliver (secondary andunspecified) ---------

Malignant neoplasmof liver not statedwhether primary orsecondary----------

Malignant neoplasmof liver,aecondary-

Other cauaea------------

ICE No.

(1)

001-E999

155,156

155

155.0

155.1

155.8

156

156A

156B

ReaidualI

Number ofdeaths in

1966

(2)

1,863,149

11,083

6,584

2,112

4,471

21

4,499

3,149

1,350

1,852,066

Eighth Revision

Estimated number of deaths in CO1. (2)that went to ICDA Nos. 155, 156 and

194-199 (primarily to 197.7 and 147.8)]

ICDA No.

(3)

155,156,197 .7,197.8

155,156,197 .7,197,8

{

151.1

156

156.0156.1156.2156.9

2155 or 156

.94-199, primarily to 197.7,197.8

194-199, primsrily to 197.8

194-199, primarily to 197.7

155,156

Numberof

deathsin 1966

(4)

10,982

10,898

6 398—L

2,008

41

4,349

...

...● .....

21

4,499

Estimatednumber of

that w&~to othercauaes

(5)

1,852,168

185

185

104

} 81

. . .

. . .,... . .2-

L3,1491,350

84 1,851,982

Numn

deathsin 1968that

went toICDA

Nos. inCol. (3)

(6)●

11,251

11,251

.

6,805

{

2,10987

4,609

2,7771,204

397231

. . .

4,446

2,981

1,465

6,805

1The titles corresponding to these ICDA numbers are aa follws:‘=ZY and intrahepatic bile ducts (ICDA NO.

Malignant neoplasms of liver specified as pri-155~ Malignant neoplasms of gallbladder and bile ducts (ICDA No. 156);

Malignant neoplasnm of other sites (ICDA Nos, 194-199);Mslignant neoplasms of liver,No. 197.7); and Malignant neoplasms of liver, unspecified (ICDA No. 197.8).

specified as secondary (ICDA

2According to the coding rules in effect with the Eighth Revision, this death waaor 156.

assigned to either No. 155

22

(341) may be taken as the minimum estimate ofthe number of deaths assigned to 156A by theSeventh Revision that were assigned by theEighth Revision to ICDA Nos. 194-199 otherthan 197.8. This estimate of 341 deaths isqualified as “minimum because the number of1968 deaths assigned to 197.8 (which con-stituted 14.35 percent of the total number inICDA Nos. 194-199) may have included somedeaths assigned by the Seventh Revision to cate-gories other than 156A.

Among the estimated 341 deaths assigned to156A by the Seventh Revision and to ICDANos. 194-199 other than 197.8 by the Eighthwere those involving malignant neoplasm ofliver, not stated whether primary or secondary,jointly reported with malignant neoplasm ofabdomen. In the Seventh Revision malignantneoplasm of the abdomen and intra-abdominalcancer were included under Malignant neoplasmwit h primary site not indicated (categorynumber 199B), and provision was made forcoding Malignant neopIasm of liver, not statedwhether primary or secondary (156A), in pref-erence to a condition classifiable to 199B. In theEighth Revision a separate subcategory isprovided for Abdomen, intra-abdominal cancer(ICDA No. 195.0) under Malignant neoplasms ofill-defined sites (ICDA No. 195), and provision ismade for coding malignant neoplasm of an ill-defined site in preference to malignant neoplasmof liver, not stated whether primary or second-ary. “As a result of this change in coding proce-dure the following example would be assigned tocategory number 156A by the Seventh Revisionand to ICDA No. 195.0 by the Eighth Revision.

I (a) Carcinoma of liver [7th, category no. 156A;8th, ICDA No. 197.8]

(b) Abdominal carcinoma [7th, category XIO.199B;8th, ICDA No. 195.0]

In the relatively small sampIe of 1966 deathscoded by both revisions none of the deathsassi<gned by the Seventh Revision to categorynumber 156A were assi~gned to ICDA numbersother than 194-199 by the Eighth Revision. It isknown from other sources, however, that somedeaths assi~g-ncd to 156A by the Seventh Revi-sion may ha~’e been assi<~ecl to numbers other

than 194-199 by the Eighth Revision. Forexample, in 1968 a review was made of 103death certificates on which cancer of the lungwas mentioned. Among these certificates wasthe following:

I (a) Cancer of liver [7th, category no. 156A;8th, ICDA No. 197.8]

(b) Metastatic cancer of h-mg [7th, ICD No. 165;8th, ICDA No. 162.1]

Because of a cha~ge iJI the interpretation of“metastatic” neopIasm of lung, the above recordwould be coded to Malignant neoplasm of liver,not stated whether primary or secondary (cate-gory number 156A), by the Seventh Revisionand to Malignant neoplasms of bronchus andlung (ICDA No. 162.1) by the Eighth. Thecoding rules in use with the Seventh Revisionprovided for the classification of malignant neo-plasm of lung qualified as “metastatic” tosecondary neopIasm of Iung. Malignant neo-phtsm of a site not specified as secondary(including liver) was coded in preference to asecondary neoplasm. According to the EighthRevision rules, malignant neoplasm of the lungqualified as “metastatic “ is not considered to bespecified as secondary. A malignant neoplasm ofthe Iiver or lymph nodes without specification asprimary is assumed to be secondary when it isjointly reported with ma.li~ant neoplasm ofanother site that is not specified as secondary.

In addition to the deaths coded to categorynumber 156A by the Seventh Revision and to197.8 by the Eighth Revision, the comparabilitystudy also showed that some deaths coded toSeventh Revision ICD No. 155.0 were assignedto 197.8 by the Eighth Revision. It is likely thatmost of the 104 deaths assigned by the SeventhRevision to Malignant neoplasm of liver (statedto be primary site) (ICD No. 155.0) and notreassigned by the Eighth Revision to primarymalignant neoplasm of liver were coded toMalignant neoplasms of liver, unspecified (ICllANo. 197.8) (table D). The 1955 multiple-causestudy shows that a significant number of deathsattributable to hfa]ignant neop]asm of biliarypassages and of liver (stated to be primary site)(IC13 ‘No. 1.55) wereliver.g According to

a’ssociatccl with cirrhosis ofthe coding rule in usc with

23

the Seventh Revision, cancer of liver, unqual-.ifiecl, indicated by tile certifier to be clue tocirrhosis of liver was coded to primary cancer ofliver (ICD No. 155.0). This rule was notincorporated in the coding instructions for usewith the Eighth Revision in time to be appli-cable to any data year prior to 1975. Prior tothis ,time deaths certified in the above-describedmanner were coded by the Eighth Revision toMalignant neoplasms of Iiver, unspecified (ICDANo. 197.8).

The Iargest component of the estimated1,184 deaths assi~gned to hlaii,gnant neoplasms ofdigestive organs and peritoneum by the EighthRevision but coded elsewhere by the Seventhwas an estimated 727 deaths assigned by theSeventh Revision to hlalignant neoplasm,primary site not indicated (category number199 B). These differences in assignments resultedprimarily from a change in the procedure forclassifying malignant neoplasm of multiple siteswith no indication as to which was the primarysite. For example, a report of “cancer ofstomach and pancreas” was coded to hkslignantneoplasm with primary site not indicated (cate-gory number 199B) by the Seventh Revision andto the first-mentioned site, cancer of stomach(ICDA No. 151.9), by the Eighth Revision. Amore detailed discussion pertaining to the classi-fication of malignant neopktsms of multiple sitesappears above under Malignant neoplasms of

buccal cavity and pharynx (ICDA Nos.140-149).

Estimates based on 1968 data that are con-sistent with the estimated number of 1966deaths assigned by the Seventh Revision to 1991Band by the Eighth Revision to ICDA NCE.150-159 (727 deaths) are presented in appendixVII.

In 1968 the death rate for Malignant neo-plasms of digestive organs and peritoneum was46.8 per 100,000 population (table 1). In 1967the death rate for this group of causes was 48,,2per 100,000 population. Based on the duaI .coding of 1966 data, however, there were91,848 deaths assigned to ICDA Nos. 150-159by the Eighth Revision and 95,079 deathsassigned to lCD Nos. 150-1 56A, 157-159 by thle .Seventh Revision. The comparability ratio fcjrthese causes, 0.9660, is obtained by dividing91,848 by 95,079. Adjusting the 1967 deathrate to the level it would have been if the 1967deaths had been coded by the Eighth Revision(48.2 multiplied by 0.9660) lowers it to 46.6deaths per 100,000 population.

Malignant neoplasms of respiratory system(ICDA Nos. 160-163).–The net effect ofchanges introduced with the Eighth Revision onthe number of deaths classified to h4alignantneoplasms of respiratory system was an increasefrom 54,934 to 56,668. The comparability ratiois 1.0316 (appendix I).

Seventh Revision


(1)

All causes .... ... ..... .. ..... . .. ... .. .. .... .. . ..... .. .. .. 001.E999

Malignant neoplasm of respiratory system, notspecified as secondary ..... .. . .... . ... .... . ... ... ... . .. ...160.164Of larynx . .. . .... .. ... ... .. .. ... . ... .. .. ... . .... . . ..... ... ..... .. ... . ..l6lOf bronchus and trachea, and of lung specifiedas primary .... .. .. .... .. .. .... .. . .... . .. .. .... . .. .... ... . ... .. . . .. ...l62

Of lung, unspecified as to whether primary orsecondary ... .... .. ... ... . . ..... . .. ... . .. .. .... . ... .. ... .. .... . .... . ..l 63

Of other parts of respiratory system,., .. . . .... ...l6O.l64

Other cOuses .. ... . .. .. .. ... . .... . .... ... . ... ... . .. .. ... ... .. ... Residual

.—

Number ofdaaths

in 1966

(2)

1,863,149

54,9342,623

20,913

30,565833

1,808,215

— —

Eighth Revision!.

Estimated number ofdeaths in column (2) Estimated number of

that went to Malignant deaths in column (2)neoplasms of that went to

respiratory system other causes

(ICDA NoS. 160-163)+

(3) (4)

56,668 1,806,481

54,5842,597

20,801

30,403783

35026

112

16250

2,084 1,806,131

24

As shown in the table above, an estimated2,084 deaths classified under the above title bythe Eighth Revision were classified to causesother than Malignant neoplasm of respiratorysystem, not specified as secondary (ICD Nos.160-1 64), the comparable Seventh Revisiontitle.

Included in the 2,084 figure were an esti-mated 1,572 deaths. The majority of these wereassigned to Malignant neopksm of thoracicorgans (secondary) (ICD No. 165) by theSeventh Revision. A limited number of these1,572 deaths probably were assigned to Malig-nant neoplasm with primary site not indicated(category number 199B) by the Seventh Revi-sion (appendix VII). A change in the classifica-tion of “metastatic” neoplasm of the lung fromMalignant neoplasm of thoracic organs (second-ary) (ICD No. 165) in the Seventh Revision toMaIignant neopksms of bronchus and lung(ICDA No. 162.1) in the Eighth Revisionaccounted for most of these differences. Theremaining differences resulted from a change inthe procedure for coding maIignant neoplasm ofmultiple sites with no indication as to primarysite. For example, a report of “carcinoma oflung and bladder” was coded to Malignantneoplasm with primary site not indicated (cate-gory number 199B) by the Seventh Revision andto the first-mentioned site, carcinoma of lung(coded to ICDA No. 162.1), by the Eighth Revi-sion. (A more detailed discussion pertaining tothe classification of maliawant neoplasm ofmultiple sites appears under Malignant neo-plasms of buccal cavity and pharynx (ICDA Nos.140-149), page 19.)

Also among the 2,084 deaths transferred toMalignant neopksms of respiratory system bythe Eighth Revision were an estimated 56 deathsassigned by the Seventh Revision to Benign neo-plasm of respiratory system. These differencesresulted from a change in the classification of“mesothelioma of the pleura” from Benignneoplasm of respiratory system (ICD h’o. 212)in the Seventh Revision to Malignant neoplasmsof pleura (ICDA No. 163.0) in the Eighth Revi-sion.

The third group among the 2,084 transferreddeaths comprised an estimated 53 deaths that

had been assigned to Tuberculosis of respiratorysystem (ICD Nos. 001-008) by the Seventh Revi-sion. These differences in assignments occurredbecause the Seventh Revision rules which undercertain circumstances resuIted in coding aninfectious or parasitic disease in preference toother reported conditions were changed in theEighth Revision. These Seventh Revision rulesapplied when two or more conditions, one ofwhich was an infectious or parasitic disease,were entered on the death certificate in such away that none could be regarded as the under-lying cause. The Eighth Revision ruIes lead tothe seIection of the first-mentioned conditionwhen causes of death are entered on the deathcertificate in this manner. A death attributableto “lung cancer and tuberculosis of lung,” forexample, was assigned to tuberculosis of lung bythe Seventh Revision rules and to cancer of lungby the Eighth Revision rules.

The assignment to other categories of about350 deaths that had been assigned to hlalignantneopksm of respiratory system, not specified assecondary, by the Seventh Revision partly offsetthe gain of about 2,084 deaths to the EighthRevision title hlalignant neoplasms of respira-tory system. An estimated 184 of these deathswere assigned to Nlalignant neoplasms ofabdomen, intra-abclomina.l cancer (ICDA No.195.0), and to hlalignant neoplasms of pelvis,pelvic viscera, rectovaginal septum (ICDA No.195. 1), by the Eighth Revision. These differ-ences in assignments resulted from a change inthe procedure for coding malignant ncoplasmsof the abdomen and pekis. In the Seventh Revi-sion these neoplasms were included under hlalig-nant neoplasm with primary site not indicated(category number 199B), and provision wasmade for coding maIignant neoplasm of aspecified site in preference to a condition classi-fiable to 199B. In the Eighth Revision malignantneoplasms of the abdomen and pelvis areinclucled under Akliamant neoplasms of ill-defined sites. W’hen malignancy of another site isindicated to be due to malignant neoplasm of aniH-defined site, assignment is to the ilI-definedsite. As a result of this change in codin~ pro-cedure the following example would be assignedto carcinoma of lung (coded to ICI) No. 163) by

25

the Seventh Revision and to abdominalcarcinoma (coded to ICDA No. 195.0) by theEighth Revision.

I (a) Carcinoma of lung(b) Abdominal carcinoma(c)

Also among the 350 deaths not reassigned toma.Ii~ant neoplasm of respiratory system werean estimated 74 deaths coded by the EighthRevision to malignant neoplasm of other sites.These transfers probably resulted from a changein the interpretation of the rules used to deter-mine whether there was more than one primaryneoplasm. When the Seventh Revision was inuse, a malignant neoplasm of a site not specifiedas either primary or secondary was assumed tobe secondary when jointly reported with aprimary malignant neoplasm, regardless of theposition of the causes on the medical certifica-tion form. When the Eighth Revision went intoeffect, this interpretation was changed. The factthat a malignant neoplasm of one site isspecified as primary is not considered evidencethat neoplasms of other reported sites aresecondary. As a result of this change in codingprocedure, the following example was assignedto Malignant neoplasm of larynx (ICD No. 161)by the Seventh Revision and to Malignant neo-plasms of breast (ICDA No. 174) by the Eighth.

I (a) Cancer of breast(b)(c)

II Primary cancer of larynx

Applying the comparability ratio of 1.0316to the 1967 death rate of 29.4 deaths per100,000 population for Malignant neoplasm ofrespiratory system, not specified as secondayy(ICD Nos. 160-164), raises this rate to 30.13deaths per 100,000 population. This is the levelthe 1967 death rate would have been if deathsfor that year had been classified by the EighthRevision. This adjustment of the 1967 ratereduces the percentage rise between 1967 and1968 from 8.16 percent to 4.95 percent. For1969 the death rate for Malignant neoplasms ofrespiratory system (ICDA Nos. 160-163) was32.7 deaths per 100,000 population. .

Malignant neoplasms of breast (ICDA No.174). –The introduction of the Eighth Revisioncaused no serious break in the comparability o:fmortality statistics for this cause. The compara- .bility ratio is 0.9913 (appendix I).

As shown in the table below there were anestimated 312 deaths in 1966 that were assigneclby the Seventh Revision to h4alignant neoplasni~of breast (ICD No. 170) and to other causes bythe Eighth Revision. Approximately one-half ofthese deaths were assigned by the Eighth Rev-i..sion to malignant neoplasm of other sites!,mainly to sites of the respiratory system and to}abdomen and peIvis. Some of these differencesin assignments occurred because of a change inthe classification of metastatic neoplasm of thelung from Malignant neoplasm of thoracicdrgans (secondary) (ICD No. 165) in theSeventh Revision to Malignant neoplasms ofbronchus and lung (ICDA No. 162.1) in theEighth Revision. As a result of this change the ,

*

Seventh Revision!

Eighth Revisiont

Estimated number ofNumber of deaths in column (2)

Estimated number of

Cause of death and category number deaths that went to Malignantdeaths in column (2)

in 1966that went to

neoplasms of breast

(ICDA No, 174)other causes

(1) (2) (3) (4)

All CZIUSCS ... . .... .. .. .. ... . .... . . .... . . .... .. .. .... . . ... OOl.E999

Malignant neoplasm of breast .,.....,. .. .. .... .. . .... .. ... ...170Other causes ... ... ... . ... .... ... .... . .. .. .. . .... .. ... ... ... .. .. Residtial

w-=%+--” :3—.-——...— .—_— —— .—— J- —.~ -.__.__ L..–.

26

following example would be ckssified to car-cinoma of the breast by the Seventh Revisionand to carcinoma of the lung by the Eighth.

I (a) Carcinoma of breast(b) Metastatic carcinoma of lung(c)

The previously mentioned change in the pro-cedure for coding malignant neoplasms of theabdomen and pelvis resulted in some deathsbeing assigned to malignant neoplasm of thebreast by the Seventh Revision and to malignaptneoplasm of the abdomen or pelvis by theEighth Revision. Malignant neoplasms of theabdomtm and pelvis were included under h4alig-nant neoplasm with primary site not indicated(category number 199B) in the Seventh Revi-sion, and provision was made for coding malig-nant neoplasm of a specified site in preferenceto a condition classifiable to 199B. In the EighthRevision malignant neoplasms of abdomen andpelvis are included under Malignant neoplasmsof ill-defined sites, and the rules provide for theassignment of mrdignant neoplasm of a specificsite which is reported as due to malignant neo-pksm of an ill-defined site to the ill-defined site.Thus the following example would have beenassigned to carcinoma of the breast (under ICDNo. 170) by the Seventh Revision and to carcino-

matosis of abdomen (under ICDA No. 195.0)by the Eighth Revision.

I (a) Carcinoma of breast(b) Carcinomatosis of abdomen(c)

Malignant neopksms of genital organs(ICDA #es. 180-187).–As shown in the tablebelow, there was no serious break in the con-tinuity of mortality statistics for Malignant neo-pksms of genital organs as a result of the intro-duction of the Eighth Revision. Thecomparability ratio for this cause is 1.0034(appendix I).

Inasmuch as the rates in table 1 are based onthe totzd population (male and female) they areof limited value. Data from the comparabilitystudy of deaths occurring in 1966 are givenbelow. The comparability ratio for malignantneoplasms of female genitaI organs is 0.9963.The corresponding comparability ratio for malig-nant neoplasms of the male genital organs is1.0133.

Malignant neopiasms of wi”nary organs(ICDA Nos. 188, 189).–The comparability ratiofor causes classified under this titie is 1.0171(appendix I). As shown in the table, page 29,

. Seventh Revision

Cause of dedth and category number

(1)

All caries .. .. .. .. .. ... . .. . .. ... .. .. .. .. .... .. . ... .. . ... . 001-E988

Malignant neoplasm of genital organs .. ... . .. ... ...l7l -I 79Of cervix uteri .. .. . .. .. .. . .... .. .. ... ... .. ... . ... .. .. . .. ... . . .. ... ..l7lOf other and unspecified parts of uterus ... ....172-174Of ovary, fallopian tube, and broad Iigamem ... ....175Of other and unspecified female genitalorgans . .. .... . .. .. .. . ... .. . ... .. .. .. .. . ... .. .. ... .. .... .. .... . .. .. ... .. . 176

Of prostate ... ... . . ... . ... .. ... . .... . . ... . . .... .. . ... .. . ... . . ... .. .. ..l 77Of all other and unspecified male genitalorgans . .. .. .... .. . . .. .. ... . .. ... . .. ... .. . ... . ... ... .. . ... .. . ... ..l 78,179

Other cauws ... . . ... .. . ... .. .... .. .... . .. ... .... .. .. .. .. . .. .... Residual

Number ofdeaths

in 1%6

(2)

1,663,149

40,3787,6655,7379,163

86615,941

1,013

1,822,771

Eighth Revision

Estimated number of

deaths in column (2)that went to Malignant

neoplasms of genitalorgans (ICDA Nos.

180-187)

(3)

Estimated number of

deaths in column (2)that went toother causas

(4)

40,516 f ,822,633

39,969 4097,562 1035,680 519,082 71

835 3015,806 135

984 19

547 1,822,224

27

Seventh Revision


in 1966

i(1) (2)

All causes .... . .. ... .. .. .... .. . ... . . ... . . ... . . ... . . ... ... 001 -E998 I 1.863.149

Malignant neoplasm of female genital organs,..l 71-176 ~Of cervix uteri . .. .. ... ... . .... . . ... ..l ... . .. . . .. ... I .. ... . ... .. ....l7l 7;66!5Of other and unspecified parts of uterus ... . ...172-174 5,731Of ovary, fallopian tube, and broad ligament .. .. ...175 9,163Of other and unspecified fema:e genitalorgans . .. ..... .. .... ... . .... . .. .... .. ... .. .... . .. . .. . .. . .. .... . .. .. .. ...l 76 865

Other causes ..... .. ... .. ... .. .. ... . .. . .. ... .. .. ... . . .. .. .. .. .. . Residual I 1,839,725

Eighth Revision


that went to Malignantneoplasms of female

genital organs (ICDAtfos. 180-1 84)

(3)

23,337

23,1697,5625,6809,092

835

168

Estimated number of

deaths in column (2)that went toother causes

(4)

1,839,812

255103

5171 .

30

1,839,557

.

Seventh Revision Eighth Revision

Estimated number of I


(1)

Number ofdeaths in column (2) Estimated number of

deathsthat went to Malignant deaths in column (2)

neoplasms of male that went toin 1866

genital organs (ICDA other causesNOS. 185-1 87)

(2) (3) (4)

All causes .. .. . ... .. ... . .. . .. ... . . .. .. . .. ... . .. .. . .. ... .. 001-E999 l,&63,149 17,179 1,845,970

Malignant neoplasm of male genital organs . ... ..l 77-179 16,954 16,800 154Of prostate .... . .... .. ... ... . ... .. .. . .. . .. .. .. . ... .. ... . .. ... .. . .... ..l 77 15,941 15,806 135Of all other and unspecified male genitalorgans . .. . .. ... .. . ... ... .. ... ... . ... .. . . . ... ... .. ... . . .... ... . ...l 78,179 1,013 994 19

O~her causes .... . ... .. ... ... . . .... .. . ... . . ... .. .. .. . . .. ... .. ... Residual I 1,846,195 I 379I

1,845,816

.

there were 14,166 deaths assigned to this titleby the Seventh Revision and 14,408 deaths as-signed to it by the Eighth Revision.

The largest component of the estimated 421deaths classified under Malignant neoplasms ofurinary organs by only the Eighth Revisionincluded about 193 deaths that were classifiedto Malignant neoplasm with primary site noti n d i cated (category number 199B) by theSeventh Revision. These transfers resulted froma change in the procedure for classifying malig-nant neoplasm of multiple sites with no inclica-

.tion as to which was the primary site. Forexample, a report of “cancer of kidney andlung” was coded to Nlalignant neoplasm withprimary site not indicated (category number199B) by the Seventh Revision and to the first-mcntionecl site, cancer of the kidney (coded toICI)A No. 189.0), hy the Eighth Revision. (Amore detailed discussion pertaining to the classi-fication of malignant neoplasm of multiple sitesappears under Il:ilignant neoplasms of buccalcavity :tncl pharynx (lCIJA Nos. 140-1 49), page19.)

28

Seventh Revision I Eighth Revision

Estimated number of

Number ofdeaths in column (2)

Cause of death and category number deathsthat went to Malignant

neoplasms of urinaryin 1966

organs (ICDA Nos.188,189)

(1) (2) (3)

All causes ... . .. ... .. .. .. ... . .. .. . ... .. . ... .. ..... . . .... . 001-E999 1,863,149 ! 14408~—. —

Malignant neoplasm of urinary organs ... .. . .. .. ...l 80,181 14,166Of kidney I

13,987.. .. . .. .. ... .. ... ... .. . ... .. . .... .. . .... . .. .. . .. ... ... . .. ... . 180 5,841 5,787

Of bladder and other urinary organs . .. .. .. .. .. . .. .... ...l8l. 8,325 8,200

Other causes .. .. .. .. ... ... . . ... .. .... .. . .... . . ..... . . ... .. . .... ResidualI

1,848,983I

421

.

,\loligna n t neoplasms of all other and

u77specifieci sites (ICDA Nos. 170-173,190-1 99). –About 2 percent more deaths wereclassified under the above title by the Eighthlle~~ision than had been classified under the com-parable Seventh Revision title (ICD Nos. 156B,165, 190-199) (appendix I). Data from thecomparability study show that an estimated4,478 deaths classified under this title by theEighth Revision were classified ekewhcre by the

Seventh Revision. On the other hand, an esti-mated 3,736 deaths classified to these causes bythe Seventh Revision were classified elsewhereby the Eighth Revision. The result was a net.increase of 742 deaths.

Among the 4,478 deaths classified{ underNlalitgnant neoplasms of all other and unspecifiedsites by the Eighth Revision were an estimated,3,149 deaths which ~vcre classified by theSeventh Revision to Llalignant neoplasm of liver,not stated whether primary or secondary (cate-gory number 156A). hlost of these differences inassignments were due to the transfer of malig-nan t neoplasm of liver, unspecified as to~ikether primary or secondary, from categorynumber 156A in the Seventh Revision to cate-gor]. 197.8 in the Eighth Revision.

As shown in the table below, the 3,736deaths assi~ndd t{) 31alignant neoplasm of otherant[ unspecified sites b? the Seventh Fk’ision



(4)

1,648,741

17954

125

1,848,562

but to other causes by the Eighth RevisionincIuded 3,307 deaths assi=gned by the SeventhRevision to MaIignant neopksm of unspecifiedsites (ICD Nos. 156B, 165, 198, 199 B).

An estimated 1,572 of these 3,307 deathswere coded to Malignant ncopksm of thoracicorgans (secondary) (ICD No. 165) by theSeventh Revision and to hlaIignant neoplasms ofrespiratory system (ICDA hTos. 160-163) by theEighth. As previously mentioned, these differ-ences resulted primarily from a change in theclassification of metastatic neopIasm of the lungfrom the Seventh Revision titIe Malignant neo-plasm of thoracic organs (secondary) (ICD No.165) to the Eighth Revision title hlaIignantneoplasms of bronchus and lung (ICDA No.162.1).

Also incIuded in the 3,307 figure were anestimated 1,587 deaths coded to category 199Bby the Seventh Revision and to malignant neo-plasm of specified sites other than those classi-fiable to ICDA Nos. 160-163, 170-173, 190-194by the Eighth Revision (appendix VII). Thesedifferences resulted from a change in the pro-cedure for classifying mali~gnant neoplasm ofmultiple sites with no indication as to which wasthe primary site.

The remaining 148 of the 3,307 deaths wereassigned b>’ the Eighth Re\~ision to causes c>thcrthan maIignant neoplasms.

29

Eighth RevisionSeventh Revision


(1)

All CSLLK%S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 001 -E988

Comparable causes ... ... . ... . .....1 56A, I 56B,1 65,190-199

Mal igtwnt neoplasm of other and unspecifiedsites 1 .. . .... .. ... .. .. .. ... .. . .. .. .. ... . .. .... ... 156B,1 65,190-199Of skin ..... .. .... . .. .... .. .... .. .. .. .. ... . .. ... ... ... ... .. .. .. 190,191Of eye .... . ... . ... . ... .. .. . .. .. .. . ... . . ..... ... ... . . .... .. . ... . .. .... . 192Of brain and other parts of nervous system ., . .....193Of thyroid gland ... .. . .. .. .. .. . .. . . .. .. .. .. .. .. . ... .. .. ... .. .. ...l94of bone .. . ... .. . .... . . ... . ... ... . . .... ... .... . ... .. . . ... . .. ... .. . ....l96Of connective tissue . .... . .. . .. .. ... .. ... .. ... .. ... . .. ... .. .... 197

Of other specified sites, not stated to besecondary .... . .. ... .. .. . . .. .... .. . ... .. . .... . .... .. . ... .. 195,’1 99A

Of unspecified sites ... . . .. .. .. .. ... . . 156 B,165,1 98,1 99BMalignant neoplasm of liver, not stated whetherprimary or secondary ... . ... .. .... .. ... .. .. . ... . .. ... .. .. ...’1 56A

Other causes ..... .. . . ... ... ..... . . ... . .. .... . . ... . .. .. .. .. . ... . Residual

Number ofcleat hsin 1966

(2)—.— .—

1,663,149 -—

38,181

35,0324,560

3587,3551,0081,7921,318

1,42217,219

3,149

1,824,968


that went to Malignantneoplasms of all otherand unspecified sites(ICDA NOS. 170-173,

190-1 99)(3)

35,774

34,445

31,2964,498

3587,1371,0081,6981,318

1,36713,912

3,149



(4)

1,827,375

3.736

.3,736

62

218

94.

553,307

1,328

1

I, B23,639

——— —— — .. ..”_ —_____

lThis is the title to which deaths in tables 1 and 2 were assigned during 1950-67, when the Sixth and Seventh Revisionsw= in ~e.

Leukemia (IC’DA Nos. 204-207). –There wasno appreciable break in the comparability ofmortality statistics for this cause as a result ofimplementation of the Eighth Revision. Thecomparability ratio is 0.9974 (appendix I). Asshown in the table below, there were 14,012deaths assigned to Leukemia and aleukcmia(ICD No. 204) by the Seventh Revision. Anestimated 13,976 deaths were assigned to thecomparable title Leukemia by the Eighth Revi-sion.

Other neoplasnas of lymphatic and hema-Lopoietic tissues (ICDA Nos. 200-203, 208,209). -–About 5 percent more deaths wereassigned by the Eighth Revision to this b~c>up ofcauses than were assigned by the Seventh Revi-sion to the comparable title Lymphosarcomaand other neoplasms of lymphatic and hema-to poictic tissues (ICI) Nos. 200-203, 205)

.

(appendix I). As shown in the table, page 31,this increase was due in large part to the assign-ment of an estimateci 585 deaths to ICDA Nos.

+

--- ,—. ——— ———.—— —w

Seventh Revision 1 Eighth Revision


(1)

Estimated number ofNumber of

deaths in column (2)deaths

that went to Leukemiain 1966

(ICDA NOS. 204-207)(2) (3)



(4)

All causes .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. OOl. E999

L1,863,149

J

13,976J

1,s49,173-—. ——- .. — . . ..-. —---- ..—..-----. -.—. .-— — _. —__ —-_

—.—-—— -—— -. —--- ---- ---- . . .. .. —. —- .. . . . .-—— — .-. ——

bu~emh and aleukemta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..2O4I

14,012

I

13,834

I178

C)ther c. IcIses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ResidualI

1,849,137 142 1 ,84s,995

-----——-—. ...— . . ..—.—-—.-..——.—.. ——-——.L.—_–——. .,- — ..—.L-_-—.—_.— .— . —— -- -__ L_,—..._— -— . - .-. ..—

30

200-203, 208, 209 by the Eighth Revision that polycythemia (vera) from IC13 No. 294 in thewere assigned ICD Nos. 294, 295, 297-299 by Seventh Revision to ICDA No. 208 in the Eighththe Seventh Revision. Most of these differences Revision.in assignments resulted from the transfer of

Seventh Revision


(1)

.All causes .... .. .... . .. ... . . .... . .. .. .. . .... .. ... . ..... . . 001 -E999

Comparable causes .. ... ..200-203,205,294,295,287-299

Lymphosarcoma and other neoplasms of lymphaticand hematopoietic tissues* ... .. .. .... . .. ... ...200-203.205

Lymphosercoma and reticulosercoma .... . .. ... .. . ...200Hodgkin’s disease ... .. .. ..... . . .... . .. ... . . ... .. ..... . .. ... .. . ..~lOther neoplasms of lymphatic and hematopoietictissues . .... . ... .. .. .. .. .. . .. ... . ... . .. ... .. . ... . .. ... . ..2O2.~3.~5

Other diseases of blood and blood-formingor~ns .. . .... . . .... . .. ... .. . .. . ... . .. . .. ... .. .. ....2 M.295.297.299

Other causes ... .. .. .. .. .. .. .. .. . ..... .. ... . . ..... .. ... . .. ... . .. Residual

Number ofdeaths

in 1966

(2)

1,863,149

17,079

15,8027,5633,412

4,827

1,277

1,846,070

Eighth Revision

Estimated number of Ideaths in column (2)

that went to OtherEstimated number ofdeaths in column (2)

neoplasms of lymphaticthat went to

and hematopoietictissues (ICDA Nos.

other causes

200-203,208,208)(3) I (4)

I16,602 1,846,547

16,063 1,016

15,478 3247,497 663,398 14i4,583 ; 244

I Th~ is the title to ~hi~h deaths in tables I and 2 were assigned during 1950-67, when the Sixth and Seventh Revisions were in use.

31

3. CEREBROVASCULAR DISEASES

The comparable Seventh Revision titie forCerebrovascular diseases (ICDA Nos. 430-438) isVascular lesions affecting central nervous system(ICD Nos. 330-334). In the Seventh Revisionthis title was included in Section VI, “Diseasesof the nervous system and sense organs, ” but theEighth Revision title Cerebrovascular diseases(ICDA Nos. 430-438) is in Section VII,“Diseases of the circulatory system.”

The comparability ratio between these twotitles for cerebrovascular diseases is 0.9905(appendix I). Although this ratio is close to1.00, there were some important changes incoding procedures, which in part compensatedfor each other. The table at bottom of pageshows that 4,516 deaths in 1966 assigned to ICDNos. 330-334 in the Seventh Revision (2.2percent) were transferred by the coding pro-cedures in effect with the Eighth Revision tocategories other than Cerebrovascular diseases(ICDA Nos. 430-438). On the other hand, about2,569 deaths not assigned to Seventh Revisioncategories 330-334 were assigned by the codingprocedures in effect with the Eighth Revision toCerebrovascular diseases.

The largest groups’ transferred from cerebro-vascular diseases were an estimated 1,249 deathsto Chronic ischemic heart disease (ICDA No.412) and about 582 deaths to AU other diseases

of arteries, arterioles, and capillaries (ICDA Nos.442-444, 446-448). The changes in coding pro-cedure resulting in the transfers to ICDA No.412 are described above in the section “Diseasesof Heart. ”

Most of the 582 transfers of deaths to theEighth Revision title All other diseases ofarteries, arterioles, and capillaries (ICDA Nos.442-444, 446-448) resulted from the Iinking ofthe conditions under this title by a provision inthe classification to Arteriosclerosis (ICDA No.440) when it is reported as the underlying cause .

of the conditions under the following categoriesof this group title: 443-444, 446. For example, afrequently encountered certificate contains thefollowing combination of diseases.

—.—---- .. . ..--—

Entries in Part I andPart 11 of certificate

—-—

1 (a) Mesenteric infarction(b) Arteriosclerosis

II Cerebral thrombosis

Final code

— . —— --- ——Seventh Revision

~Number of

Cause of death and category number deathsin 1966

(1) I (2)

All causes .... .. ... .. . .. . ... ... .... . . .. .. . .. .. . .. . . .. . ... 001 -E999

Vascular lesions affecting central nervoussystem .... . .. .... . .. ... .. . ... . . ... . .. ... . . ... .. .. .. . . .. .. .. .... . ..330-334Subarachnoid hemorrhage ... . . .... . . .... . . ... . . ... . ... .. .. ...33OCerebral hemorrhage .. ... . . .. .. . .. ... . .... . . ... . . .. .. ... .. ..<...331Cerebral embolism and thrombosis . . ... . .. .. . . ... .. . .....332Other vascular lesions affecting central nervoussystem ... ... . ..... . . .... . .. . .. . . .... . . .. .. .. ... . .. ... . .... .. ....333.334

Other causes ... .. .. ... .. . ... . .. ... . .. .. .. . ... .. .. .. .. . .. .. . .. .. ResicfUal

— - .—— ,.—.- .. ..—

Category number

T

7th Rev. 8th Rev.

570.2 444.2450.0 440.9

332 433

332 444.2

l==1,863,149

204,8418,531

111,44663,943

I 20,921

I 1,658,308

Eighth Revision

Estimated number ofdeaths in column (2)that went to Cerebro-

vascular diseases (ICDANOS. 430438)

(3)

202,894

200,3268,287

109,400

62,937

19,701

,



(4)*

1,660,255

4,516244

2,0461,006

1,220

2,569 1,655,739

32

By the Seventh Revision, after arterioscle-rosis was selected as the presumptive underlyingcause of death (taken to be the underlying causeof the mesenteric infarction), the assignmentwas modified by the ‘provision that if arterioscle-rosis appeared on the certificate with mention ofany condition in ICD Nos. 330-332, 334, thecombination was coded. That is, the death wasassigned to the specified cerebrovascular disease.By the linking provided by the Eighth Revisionbetween arteriosclerosis and mesenteric infarc-tion, the presumptive underlying cause is takento be the mesenteric infarction.

Thus, despite the fact that both the Seventhand Eighth Revisions provide for the linkage ofcerebrovascular disease with mention of arterio-sclerosis, the finaI assignment by the EighthRevision of the above certificate is to the firstcondition linked with arteriosclerosis-that is,the assignment is made to ArteriaI embolism andthrombosis of mesenteric artery (ICDA No.444.2).

The largest transfers to Cerebrovasculardiseases (ICDA Nos. 430438) from SeventhRevision categories other than 330-334 werefrom: Accidental falls (ICD Nos. E900-E904),about 377 deaths (with other accidents onlyabout 47 deaths); Other arterial diseases (ICDNos. 452-454, 456), about 311 deaths; Func-tional disease of heart (ICD No. 433), about 272deaths; General mteriosclerosis (ICD No. 450),331 deaths; and h4alignant neoplasms, includingneoplasms of lymphatic and hematopoietictissues (ICD Nos. 140-205), about 178 deaths.

The changes in coding procedures resultingin the transfers from Accidental falls and fromFunctiom-d disease of heart are described above

. .—

in the section “Diseases of Heart” (page 5).The assignment of about 311 deaths from

Other arterial diseases (ICD Nos. 452-454, 456)in the Seventh Revision to Cerebrovasculardiseases (ICDA Nos. 430438) in the EighthRevision resulted primarily from the reclassifica-tion of occlusion of carotid artery from Arterialembolism and thrombosis (ICD No. 454) toOcclusion of precerebral arteries (ICDA No.432). In addition, about 64 deaths assigned bythe Seventh Revision to Other aneurysm, exceptof heart and aorta (ICD No. 452), were assi~medby the Eighth Revision to Subarachnoid hemor-

rhage (ICDA No. 430). This change resultedfrom the reclassification of berry and miliaryaneurysm (of the brain) from ICD No. 452 toICDA No. 430.

Most of the transfers from General arterio-sclerosis (ICD No. 450), an estimated 248 out ofthe 331 deaths, were coded by the EighthRevision to Other cerebrovascular diseases(ICDA Nos. 437, 438). This transfer resultedfrom shifting the terms “cerebral ischemia” and“cerebral insufficiency” to the Eighth Revisiontit 1e Generalized ischemic cerebrovasculardisease (ICDA No. 437). In accordance with theSeventh Revision these terms were includedunder Other diseases of brain (ICD No. 355). Bythe Seventh Revision, when a cause classifiedunder Other dkeases of brain (with theexception of cerebral atrophy) was reported onthe certificate as due to arteriosclerosis, thedeath was coded to arteriosclerosis and not tocerebrovascular disease.

Both the Seventh and Eighth Revisionsprovide for the modification of the provisionallyselected underlying cause when such modifica-tion results in a more useful and informativecondition for tabulations of mortality data. Forexample, as discussed above, if arteriosclerosis, ageneralized disease, has been provisionallyselected as the underlying cause for a certificateon which a cerebrovascular dkease also isreported, both the Seventh and Eighth Revisionsprovide for the assignment of the death to thecerebrovascular disease. The provisionallyselected underlying cause (arteriosclerosis) is“linkcd” by the rules for cb.ssification tocerebrovascuktr diseases (and to a number ofother diseases), and the combination of arterio-sclerosis and the cerebrovascular disease is codedto tie cerebrovascular disease. Thus when theterms “cerebral ischemia” and “cerebral insuf-ficiency” were transferred to Other cerebro-vascuh.r diseases (ICDA Nos. 437, 438), thecertificates on which these terms appeared witharteriosclerosis were assi,gned by the EighthRevision to the indicated cerebrovascular dis-ease.

The transfers from hlali<gnant neopksms,including neoplasms of lymphatic and hema-topoictic tissuts (ICD Nos. 140-205), toCerebrovascular diseases (ICDA Nos. 430-438)

33

resulted for the most part from a modificationof guides for determining the probability ofsequences. In accordance with coding proce-dures in effect with the’ Seventh Revision(beginning with 1959 for this particular proce-dure), any intracranial disease in ICD Nos.330-334 reported as due to a malignant neo-pIasm was classified to the neoplasm as theunderlying cause of death. But with the EighthRevision the coding procedure was changed sothat not every one of the intracranial vasculardiseases reported as due to a maIignant neoplasmwould be assigned to the malignant neopIasm.

Although the introduction of the Eighth

Revision for data year 1968 did not produce anyappreciable break in the comparability ofmortaIity statistics for the entire group ofcerebrovascuIar diseases, it did produce a con-siderable degree of discontinuity for the com-ponents of this group of diseases. One of thereasons for the lack of comparability for thecomponents is that while the Sixth and SeventhRevisions were in use (1949-67) cerebrovasculardiseases were distributed among only fivecomp orients, but according to the Eighth Revi-sion they are distributed among nine compo-nents (table E).

Table E. Deaths from Eighth Revision category Cerebrcwasculardiseases, distributed by the Seventh Revision categories: UnitedStates, 1966

lLkarhs arc those occ.rri.. withind,.U.itcd Sums. Scvcnch Revision cacceoric. for which dm number of deaths was less than 5 ucrccnt ofthenumberassicncdcotheEiehthRcvisicm.—__—— ———— —=

Eighth Revision

ICDANo.

(1)

MD-438

Category tit le

(2)

Cerebrovasculardis-eases-----------------

——. .

Estf.-matednumber

ofdeaths

(3)

202,942

.at;goq’orw= k than100arcnotshownI

.—

- —.— ._—

ICO No.

(4)

330-334

450

452-454,456

433

E903

341-344,352,354-369,380-384,386,388-390,394-398

E900-E902

E904

---

Seventh Revision

Category tit le

(5)

Vascular lesions affect-ing central nervoussystem------------------

General arteriosc’lero-Sis---------------------

Other arterial diseases--

Functional disease ofheart-------------------

Fall on same Level-------

Other diseases of nerv-ous system and senseorgans------------------

Fall from one level tosnothcr-----------------

Unspecified falls--------

Other categories---------

Total

Esti-matednumber

de%hsg;~t~

Rsvisioncategory

(6)

200,364

331

312

268

176

106

101101

1,183

202,942

.

Col.;6) asI per-centofCol.(3)

(7)

98.7

0.2

0<2

0.1

0.1

0.1

0.0

0.0

0.6

G-6

.

—.

Final:Ount ofdeathsfor

;eventhkviaioncate-goriescompa-rabletoEighthkvision:ategory

(8)

204,841

@

@

*

@

@

@

@

@

Col.

~6~e~

:ent ofCol.(8)

(9)

.

97.8

...

...

.,.

...

...

...

,..

,..

+

f?- Category not comparable to Eighth Revision category.

34

Table C. Deaths from Eighth Sevinion.

category Cerabrovasculardiseases, distributed by the Seventh Revision categories: UnitedStates, 1966-Con.

[Deathsam the=occurrinz withintheUmimd.hatcs.SeventhRevisioncatcmxicsforwhichchcnumberofdeathswaslessdmn 5pcrccncofthenumberAgncd co cbc Egh!h Revisioncakgoryorw= 1- than100arcnotshown]

——

Finalcount Oideaths

forSeventhRevieioncate-goriesccirlpa-

rable toEishth

Rmvisimcategory

(8)

(81:st per-:ent OECol.

(s)

(9)

Eighth Revision Seventh Re.vision

(81:sa w=cent

of

Col.(3)

(7)

Esti-matednumber

ofEsti-❑atednumber

de%hs

(3)

IOD~

(1)

Category title

(2)

ICD No.

(4)

Category tit le

(5) (6)

.$30 Subuachnoid hemor-rhage----------------- S,723 33C

---

Subarachnoid hemorrhage--


S,459

264

S,723

97.C

3.C

G

8,531

c

99.2

...

46.9

...

. Total

431

433

Cerebral hemorrhage---- 52,616

57,600

1,272

331

.-.

Cerebral hemorrhage------

other categories---------

Tol:al

52,247

369

52,616

99.3

0.7

Xirc

111,446

C?

. cerebral thrombosis---- 332 Cerebral embolism andthrombosis--------------


Tot.sl

56,311

1,2S9

57,600

63,943

@

97.8

2.2

100.0

S8.1

...

434

432,435

cerebral NIIbdism------ 332

.-.

Cerebral ●mbolism andthrombosis--------------


Total

1,244 97.8

2.2

100.0

63,943

@

1.9

...28

1,272

Other specified acutecerebrwaacular dis-ease8----------------- 3,776 332 Cerebral embolism and

tltrrnbosis-------------- 2,903

498

220

76.9

13.2

5.8

4.1

100.0

63,943

@

@

@

4.5

...

...

...

331

452-454,456

cerebral hemorrhage------

Other artbrial diseasee--

Other categories---------Totd

155

3,776

436 Acute but ill-definedcertsbrcvasculardis-●ase------------------ 51,168 331

333,334

Cerebral hemotrhsge------ 46,773 91.4

7.s

1.1

100.0

L11,446

@

@

4s.9

...

...

Other vascular lesicns●ffecting central nerv-ous system-------------- 3,815

580

51,168


Total.

437,438 Other cerebrovasculardiseases-------------- 27,787 333,334 Othek vascular lesions

aff&cting central nerv-ous system-------------- 14,762

10,449

53.1

37.6

6.0

0.9

2.4

100.0

20,921

111,446

@

c?

@

70.6

9.4

...

...

...

331

332

Cerebral hemorrhage------+Cerebral embolism andthrombosis--------------

General arteriOsclercmis-

Other categories----------

Total

1,659

248

669

27,787

450

---

@ = Category not cmnparable to Eighth Revision category.

35

4. ACCIDENTS

The comparabi~ity ratio for Accidents (with As shown in the three tables, beiow, thi:smotor vehicle and other accidents taken to- reduction in the number of deaths assigned together) between the Seventh Revision (ICD Nos. Accidents by the Eighth Revision over theE800-E962) and Eighth Revision (ICDA Nos. number assigned by the Seventh RevisionE800-E949) was 0.9570 (appendix I). resulted primarily from transfers from accidents

Seventh Revision


(1)

All causes ... .... .. . ..... .. ... .. .. .. . .. ... .. . .. .. . . .... .. 001-E999

Accidents .. . .... .. . .... .. . .... . .. .. . ... .. .. .. ... . . ... .. .... . E800-E962Railway accidents . ... ... . .. ... . . ... .. . .... . .. ... . .. ... E800-E802Motor vehicle accidents ... ... .. ... . .... . ... .. .. . ... E81 O-E835

Motor vehicle traffic accidents .. .. . ... .. . ... . E81 O-E825Motor vehicle traffic accident involving collisionwith railmy train . .. .. .. .. . ... .. .. .. .. . .. .. .. ... .. . .... .. . E81 O

Motor vehicle traffic accident to pedestrian .. E812Other motor vehicle traffic accidents involvingcollision ... .. .... .. . .. .. .. .. ... .. ... . ... .. .. ..E8l I,E813-E81 9

Motor vehicle noncollision trafficaccidents ... . .... .. .... . .. .... .. .. .. .. .... .. .. ... . .... E820-E824Motor vehicle traffic accident of unspecifiednature . . ..... .. ... .. .. ... . ... ... . . ... .. . ... .. .... .. . .... . . ... .. .. E825

Motor vehicle nontraffic accidents .. .. . .... E83C-E835Other road vehicle accidents .. . . ... .. . . ... . . .... . E840-E845Water transport accidents ... .. ... ... .. .. ... . .. .... E850-E858Aircraft accidents . . .... . .. ... . . .. . ... . ... . .. .. .. .. ... . E860-E866Accidental poisoning by solid and liquidsubstances .. .... . ... .. ... . .. ... . .. .. .. .. ... .. . ... ... .... . E870-E888

Accidental poisoning by gasas and vapors... E890-E895Accidental falls . .. . .... .. . .... . .... .. .. .. . ... .. . ... .... . E900-E904

Fall from one level to another . .. .. ... . .. ... . . E900-E902Fall on same level .. .. . ... . . .... .. ... ... .. .. . .. ... .. .. .. ... . .. E903Unspecified falls .. .. .. ... .. . .... . . .... . . ... . .. .... .. . ... .. .. .. E904

Blotifrom falling or projected objact or missile... E91 OAccident caused by machinery ... .... .. .. .. .. .. .. .... .. . E912Accident caused by elactric current .. .. .. .. . ... .. .. ... E91 4Accident caused by fire and explosion of combustiblematerial .... . ... . .. ..... . ... .. .. . ... . . ... .. . ..... . . ... ... .. .. .. .. .. . E916

Accident caused by hot substance, corrosive liquid,steam, and radiation .. ... . .. .. . .. ... . .... . . .... . .. .. E917, E91 8

Accident caused by firearm .... . . .... . . .... .. . .... ... .. . .. E919Inhalation and ingestion of food or othar objectcausing obstruction or suffocation ... . .. ... . E921 ,E922

Accidental drowning .. ... . . .... . . ... ... .... .. . ... .. .. .. . ... .. E929Excessive heat and insolation ... .. . ... ... ... ... . .. ... . ... E931

Complications due to nontherapeutic medical andsurgical procedures, therapeutic misadventure,and late complications of therapeuticprocedures .. .. .. .... .. . .... .. ... .. .. .. ... .. ... . .. .. .. . ... E940-E959

All other accidents .... .. E911,E913,E91 5, E920,E923-E928, E930, E932-E936, E969E962

Other causes ... . ... .. .. ..... .. .... . .. .. .. . ... .. . ... .. .. ... .. . .. Residual

__- ——..—. —_. ————-——

Number of

deathsin 1966

(2)

~s3,149

113,5631,027

53,04151,933

1,8008,675

22,641

14,291

4,5261,106

2921,6301,510

2,2831,648

20,0665,7725,5938,7011,4592,0701,025

8,084

4092,558

1,8315,687

531

1,411

7,001

1,749,586

..Eighth Revision


that went to Accidents(ICDA NOS. E800-E949)

(3)

108,663

106,4551,000

52,45651,373

1,7578,612

22,287

14,202

4,5051,063

2821,6301,486

1,8C61,523

16,9%5;3124,8396,7551,4321,9891,025

7,813

3372,189

1,6725,431

430

1,129

5,909

2,228



(4).L.

l,754,46g

7,10;27

585560

4363

344

.

2125

,-

24

477125

3,160460754

1,8462!7 ,81

,-

271

72 .

369

159

2561Cll

282

I ,092

1,747,358

36

.

.

Seventh Rwision


(1)

All CSUS8S............................... ................ 001 -E999

Motor vehicle accidents ............. ................ . E81 O-E835Motor vehicle traffic accidents ................. E81 O-E825

Motor vehicle traffic accident involving collisionwith railway train ........ ........... ..... ....... ............ E81 oMotor vehicle traffic accidant to pedestrian .... E812Other motor vehicle traffic accidants involving

. .collmon. . ......... ...... ....................... E81 1,E813-E819Motor vehicle noncollision trafficaccidents ......................................... ...... E820-E824Motor vehicla traffic accident of unspecifiednature .......................... ................................... E825

Motor vehicle nontraffic accidents ...... ..... E830.E835

Other causes..... ........... ...................... ............. Residual

Numbar ofdeaths

in 1966

(2)——

1,663,149

53,04151,933

1,6008,675

22,641

14,291

4,5261,108

1,810,108——. -—

-—Eighth Revision

Estimsrted number ofdeaths in column (2)that want to Motor

vehicle accidents (ICDANOS. E81 O-E823)

(3)

52,622

52,25051,243

1,7578,570

22,274

14,158

4,4641,007

372

Estimated number ofdeaths in column (2}


(4)

1,810,527..—. -. -

791690

43105

367

133

42101

1,809,736

other than motor vehicle accidents. The com-parability ratio for Motor vehicle accidents(ICDA Nos. E81 O-E823) between the Seventhand Eighth Revisions was close to 1.00–actually0.9921, but the comparability ratio for AU other

accidents (ICDA Nos. E800-E807, E825-E949)was onIy 0.9250 (appendix I).

Three major changes between the Seventhand Eighth Revisions that resulted in the trans-fer of a substantial number of deaths formerIyattributed to All other accidents (ICD Nos.E800-E802, E840-E962) are summarized below.

(1) An estimated 1,923 of the 6,751 deathstrmsferred from these accident categories wereassigned by the Eighth Revision to the followingnew title introduced for classifying deaths forwhich it was not possible for the certifier todetermine whether the injuries were accidentallyor purposely inflitted: Injury undeterminedwhether accidentally or purposely inflicted(ICDA Nos. E980-E989). These 1,923 deathsthat were f orrnerly assigned to accidents(excluding motor vehicle accidents) constituteabout 63 percent of this new category. (Deathsassigned by the Seventh Revision to Suicidemake up about 31 percent of the new category;and those assigned to Homicide, about 2 per-cent.)

(2) The second lamest noup transferredfrom ~ese accidents was-1,773 de~ths that wereassigned to the Eighth Revision title Diseases ofheart. As stated above in section 1 of this report,“Diseases of Heart,” an estimated 1,422 of thedeaths transferred from All other accidents wereassigned by the Eighth Revision to Ischemicheart disease (ICDA Nos. 410-413), and theimportant changes in the coding procedures foraccidents that resulted in this transfer of deathsare summarized in that section. It is believedthese same changes in coding proceduresbetween the Seventh and Eighth Revisionsaccount for the most part for an additionalestimated 424 deaths that were assigned by theSeventh Revision to these accidents being trans-ferred by the Eighth Revision to Cerebrovasculardiseases (ICDA Nos. 430-438).

In summary, an estimated 3,188 of these6,751 transferred deaths were fatalities resultingfrom fzdls. About half of these 3,188 deathswere transferred by the Eighth Revision toIschemic heart disease (1,171 deaths with fallsinvolved) and to Cerebrovascular diseases (377deaths with falls involved) (appendix I).

(3) An estimated 319 of the 6,751 trans-ferred deaths were assigned by the Eighth Revi-sion to Pneumonia (ICDA h’os. 480-486). About

37

Seventh Rwision


(1)

All causes.............. ................................. 001 -E999

All other accidents .................. E800-E802,E840-E962Railway accidents. .................................... E800-E802Other road vehicle accidents ....... ..... ......... E840-E845Water transport accidents .......... ............... E850-E858Aircraft accidents ..................................... EB60-E866Accidental poisoning by solid and liquidsubstances............... ................................ E870.E868

Accidental poisoning by gesesand vapors. E890-E895Accidental falls.., .................. ............ ........ E900-E904

Fall from one level to another ................ E900-E902Fall on same level ..................... ....................... E903Unspecified falls ................................ .......... .... E904

Blow from falling or projectad objact or missile... E91 OAccidant causad by machinery ................. ......... E912Accident caused by elactric current .. .............. ... E914Accidant caused by fire and explosion ofcombustible material ........................................ E916

Accident caused by hot substance, corrosivaliquid, steam, and radiation ..................... E917,E91 8

Accidant caused by firearm ........................ ..... .. E919Inhalation and ingestion of food or other objectcausing obstruction or suffocation .......... E921 ,E922Accidental drowning ........................... ........... ... E929Excessive heat and insolation ............................ E931Complications due to nontherapeutic madical andsurgical procedutas, tharepautic misadventure,and late cortrplications o? therapeuticprocedur& ..................... ............... ........ ... E940-E959

All other accidants ...... E91 1,E913,E91 5,k920,E923-. E928,E930,E932-E936, E960.E962

Other causas................................................. .. Residudl

Number ofdeaths

in 1966

(2)

1,863,149

60,5221,027

2921,6301,510

2,2831,648

20,0665,7725,5938,7011,4592,0701,025

8,084

4092,558

1,8315,687

531

1,411

7,001

1,602,627

53 of these 319 cleaths were assigned by theSeventh Revision to Inhalation and ingestion offood or other object causing obstruction orsuffocation (ICD Nos. E921, E922); and it ispossible that an additional 119 of them wereassigned by the Seventh Revision to Foreignbody entering other orifice (ICD No. E9 23). Theresulting total of 172 deaths were transferredfrom these accidents to the Eighth Revisioncategory Pneumonia, unspecified (ICIIA NTO.486), These transfers were probably made as aresult of the provision that when such a discrtseas Pneumonia, uns~ccificd OCDA No. 486), isthethe

38

. ,.resulting ciisease cOnditi[]n 0( such accicknts,

assib~lmcnt is to bc rnwlc to the rtxulting

Eighth Revision


that went to All othereccidents (ICDA Nos.

E800-E807,E825-E949)(3)

55.983

53,7711.000

-2821,6301,486

1,8061,523

16,8785S124,8396,7271,4051,9361,025

7,788

3372,188

1,6725,431

430

1,128

5,814

2,212


that want toothar causas

(4)

1,807,166

6,75127,-.-

24 *

47’7125

3.18S“w) -

7541,974

54134

.-

72

159

101

28:2

1,187

I 1,800,41 !5

.

disease condition and not to the accident. (Inboth revisions if this aspiration of food resultedfr~m a disease which presumably affects the .ability to control the process of swallowing, forexample, cancer of the throat or a diseaseresulting in paralysis, the assignment is to thestated underlying disease. Also in both revisionsasphyxia from aspiration of mucus or vomituswhich resulted from a disease is cociecl to thedisease.)

Partly compensating for the 6,751 deathstransferred frotn these titles for accidcntnl fat:d-itics were 2,212 deaths tr:msfcmul hy the Kight’hRevision from other cailscs to these titles.

5. INFLUENZA AND PNEUMONIA

.

The introduction of the Eighth Revisionresulted in assigning about 4 percent moredeaths to Influenza and pneumonia (ICDA Nos.470-474, 480-486) than had been assigned bythe Seventh Revision to the most nearIy com-parable title, Influenza and pneumonia, exceptpneumonia of newborn (ICD Nos. 480-483,490-493) (appendix I). About 5,355 deaths notassigned to ICD Nos. 480-483, 490-493 by theSeventh Revision were transferred by the codingprocedures in effect with the Eighth Revision toICDA ‘Nos. 470474, 480-486, while about2,557 deaths that were assigned by the SeventhRevision to ICD Nos. 480483, 490-493 weretransferred by the coding procedures in effectwith the Eighth Revision to categories otherthan ICDA Nos. 470474,480486.

As shown in the table below, the largestgroup transferred to Influenza and pneumoniaby the Eighth Revision was an estimated 2,232deaths that had been assigned by the SeventhRevision to Pneumonia of newborn (ICD No.763). This transfer reflects a change in classifica-tion providing that only diseases specific to thenewborn (e.g., hemolytic disease of the new-

born) be included under the title Certain causesof mortality in early infancy (ICDA Nos.760-769.2, 769.4-772, 774-778), and that condi-tions not different from those classified outsidethe perinatal classification, such as pneumoniaand diarrhea, be excluded. Tabulations of deathsassigned by the Eighth Revision to Pneumonia(ICDA Nos. 480-486). for all infants will give thenumber for this age group dying from pneu-monia. The Seventh Revision title Pneumonia ofnewborn (ICD No. 763) was limited to deathsfrom Pneumonia (ICD Nos. 490493) and inter-stitial pneumonia (unspecified), an inclusionterm under ICD No. 525, at ages under 28 days.Therefore tabulations of 1968 deaths at agesunder 28 days assigned by the Eighth Revisionto Pneumonia (ICDA Nos. 480-486) will give theapproximate number that would have beenassigned to Pneumonia of newborn (iCD No.763) if the Seventh Revision had been used for1968.

Another large group transferred to Influenzaand pneumonia by the Eighth Revision wasabout 1,472 deaths that had been assigned bythe Seventh Revision to Other chronic inter-

Cause of death and catagory number

(1)

Seventh Re&ion

Numbar ofdeaths

in 1866

(2)

.All causes ... .. ... . . ... . ... . ... .. .. . .... . .. .. .. ... .. . .... 001 -E999

Selected causes .. .... . .. ... . . ... ...480483.490-493.525.763Influenza and pneumonia, except pneumonia ofnewborn’ . ..... .. . ... .. . ... .. .. . .. ... .. . ... . ... .. .. . ... .. . ... .48Q493influenza ... .... . .. ... .. ... .. .. .. .. . .. .. ... .. .. .. .. . .... .. ....4~4=Pneumonia, except pneumonia of newborn .490493

Lobar pneumonia .. .. .. .. ... . . .. . ..... . . ... .. ..... .. . ... .. . ...49O8ronchopneumonia .. .. .. .. . ... . . ... . .. .. .. .. . .... . .. .. . . ....49lPrimary atypical pneumonia . .... . . .. .. ... ... . . . ... . ....492Pneumonia, other and unspecified .. .. .. .. ... .. .. .....493

Other chronic interstitial pneumonia ... . .. .... .. .. .. ....525Pnaumonia of newborn .. .. .. .. .... .. .... .. ... . .. .. .. . . .... ....763

Othar causes .... . .... .. .. ... . .. .. .. . .. .. . .. .. .. .. . ... .... .. .. .. Residual

1,863,149

70,363

63,6152,830

60,7858,864

33,2765,729

12,9164,2712,477

1,792,786

Eighth Revision

Estimated number ofdaaths in column [2)

that went to I nf Iuarrzaand pneumonia (ICDANOS. 470474,480486)

(3)

66,413

64,762

61.0582,663

5s,375S,565

31,9495,409

12,4521,4722,232

1,651


that want toother causes

(4)

1,796,736

5,601

2,557147

2,410299

1,327320464

2,799245

1,791,135

1~hi5 is the ~itle to which death5 jn tables I and 2 were assigned during 1950-67, when the Sixth and seventh Re~~ions were ‘n we.

39

stitial pneumonia (ICD No. 525). The 4,271deaths in 1966 assigned to this Seventh Revisiontitle were reassigned by the Eighth Revisionprimarily to the following titles: (1) Otherchronic interstitial pneumonia (ICDA PJo. 51 7),about 2,656 deaths, and (2) Acute interstitialpneumonia (ICI)A No. 484), about 1,400ckaths. The transfer of these 1,400 deaths to thelatter title resulted from shifting the terms“interstitial pneumonitis” and “interstitial pneu-monia,” not otherwise specified, to the EighthRevision title Acute interstitial pneumonia(ICDA No. 484).

The transfers from Influenza and pneumoniaby the Eighth Revision are quite widely distrib-uted over the classification. Each of the threetransfers, however, involved over 200 deaths.

One of these three resulted from the changein assignment of the combination of pneumonia

- and alcoholism (with alcoholism in the “due to”position on the certificate) from Pneumonia,other and unspecified (ICD No. 493), hy theSeventh Revision to Alcoholic addiction (ICDANo. 303.2) by the Eighth Revision.

Another of these changes was the transfer ofabout 213 deaths from Pneumonia (ICD Nos.490-493) to Nutritional marasmus (ICDA No.268) and to Other and unspecified nutritionaldeficiency (ICDA No. 269.9). In the SeventhRevision the terms athrepsia, cachexia, extremewasting, marasmus, and inanition were con-sidered to be ill-definecl conditions and deathsfrom these conditions at ages 1 year and overwere assigned to causes under Senility and ill-defined diseases (ICD Nos. 790-795). Con-sequently, in accordance with the SeventhRevision, in the event that the provisionaHyselected underlying cause was one of theseconditions and some condition other than an ill-defined condition was also reported, e.g., pneu-monia, the other condition was usualIyreselected as the underlying cause of death. Butby the Eighth Revision, inasmuch as the termsathrepsia, cachexia, extreme wasting, marasmus,and inanition are no longer classified underSymptoms and ill-defined conditions (ICDANos. 780-796), no reselection of another condi-tion on the certificate as the underlying cause of(Icath is made. Instead, hy the Eighth Revision,if tl]e conc!ition selected as the unckrlying cause

..is ath repsia, cachexia, extreme wasting, ormarasmus, the death is assigned to Nutritionalmarasmus (ICDA NTO.268), and if the conditionselected as the underlying cause is inanition, thedeath is assigned to Other and unspecified nutri-tional deficiency (ICDA No. 269.9).

About 208 deaths transferred from pneu-monia in the Seventh Revision to Other diseasesof respiratory system (ICDA Nos. 501-508, 512,514-516, 519) in the Eighth constituted thethird group of transferred deaths. It is beIievedthat most of these transfers are attributable tothe shift of a number of terms included by the .

Seventh Revision under the pneumonias to othercategories by the Eighth Revision. Among suchterms were “lipoid pneumonia,” which by theEighth Revision is included under Other diseases -of lung (ICDA No. 519.2), and “adynamic pneu-monia” and “asthenic pneumonia,” which bythe Eighth Revision are included under Pul-monary congestion and hypostasis (ICDA No.514).

The 1968 death rate (36.8 deaths per100,000) for Influenza and pneumonia (ICDANos. 470-474, 480-486) is 27.8 percent higherthan the 1967 death rate (28.8 deaths per100,000) for Influenza and pneumonia, exceptpneumonia of newborn (ICD Nos. 480-483,490-493). Applying the factor 1.044 to the1967 death rate, however, raises it to 30.1deaths per 100,000, the level it would havereached if deaths in 1967 had been coded by theEighth Revision rather than by the Seventh. Theremaining increase in this death rate for 1968(36.8 minus 30.1, or 6.7 deaths per 100,000 “population) may be attributable to the wide-spread influenza epidemic in 1968.

The comparability ratio for Influenza .bet we en the Seventh Revision (ICD Nos.480-483) and Eighth Revision (ICDA Nos.470-474) is 0.9572 (appendix 1), As shown inthe table below, this reduction in the number ofdeaths assigned to influenza by the Eighth Revi-sion (2,709 deaths) from the number assiagnedby the Seventh Revision (2,830 deaths)amounted to 121 deaths.

This reduction is attributable in ,great part tothe dropping by the Eighth Revision of thepriority given by the Seventh Revision to influ-enza when two or more conditic)ns arc entered

40

Seventh Revision IEighth Revision


(1)

Number ofdeathsin 1966

(2)


thet went to I nf Iuenza

(ICDA tdos. 470474)(3)



(4)

All causes .. . . .. ... .. .... .. .. .. . . ... . .. .. .. .. ... . . ... .. . . 001-E989 l,m3,149 2,709 1,860,440

lnfluenm .... .. .... .. ... .. .. ... .. .. .. . .. ... . .. .. .. . ... . .. .... .. ...4~4~ 2,830 2,676 154

Other causes ..... . .. .... .. . ... .. . ... .. ... .. . ... .. ... .. . ... .. . .. Residual 1,560,319 33 1,&50,286I I I

on the certificate in such a way that none ofthem can be regarded as the underlying cause.Most of these transferred deaths assigned by theSeventh Revision to influenza were assigned bythe Eighth Revision to Acute myocardial infarc-tion (ICDA No. 41 O) (32 deaths), Chronicischemic heart disease (ICDA No. 412) (32deaths), and to the remainder of the diseases ofthe circulatory system (38 deaths).

Most of the transfers resulting in breaks in

continuity of mortality statistics for Pneumonia(ICDA Nos. 480-486) have been described abovein the discussion of Influenza and pneumonia.As shown in the table below, an estimated 4.8percent more deaths were assigned by the EighthRevision to Pneumonia (ICDA Nos. 480486)than were assigned by the Seventh Revision toPneumoni~ except pneumonia of newborn (ICDNos. 490-493) (appendix I).



in 1866

(1) (2)

I

All causes .. .. ... ... . .. ... .. ... .. ..... . .. ... .. . .. .. ..... . 001-E9S9 I 1,663,149.

Selected causes . .. .. ... .. . .. .. .. ... .. . ... . .. ... ..49M93.525.763Pneumonia, except pneumonia of newborn 1.490493

Lobar pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..49O

Bronchopneumonia ... .. .. ... .. .... . .. ... ... .. .. .. .. .. . .... . ...491Primary atypical pneumonia .... . . ... . .. ... ... . .. .. .. .. .. . .492Pneumonia, other and unspecified .. .. .. ... .. .. .. . ... ...493

Other chronic interstitial pneumonia .. . ... . .. .. ... ......525pneumonia of newborn ... .. ... .. .. .. .. .. . .. .. . ... . .. ... . .. ....763

60;7858,864

33,2765,729

12,9164,2712,477

Other muses .. .. . .. .. .. . ... . . .... . . ... .. ... ... . .. .... .. .. .. . ... Residual I 1,795,616

I


that went to Pneumonia

(ICDA NOS. 480486)(3)



(4)

63,704 I 1,799,4451

62,079 5,45456,375

8,56531,949

5,40812,452

1,4722,232

2,410299

1,327320464

2,799245

1,625 I 1,793,991lThis is the title to which deaths in ~bles I and 2 were assigned during 1950-67, when the Sixth and Seventh Revisions were in we.

41

6. CERTAIN CAUSES OF MORTALITY IN EARLY INFANCY

The Eighth Revision reduced deaths assignedto Certain causes of mortality in early infancy(ICDA NOS. 760-769.2, 769.4-772, 774-778) by8.17 percent from the number assigned by theSeventh Revision to the comparable causeCertain diseases of early infancy (ICD Nos.760-776). This percentage, based on coding thesample of deaths in 1966 by both the Seventhand Eighth Revisions, represents a reductionfrom 51,644 deaths by the Seventh Revision to47,425 deaths by the Eighth Revision (appendixI and table below).

It may be assumed that the “8.17 percentreduction found for the sample of 1966 deathsalso is close to the percent reduction between1967 and 1968 that is attributable to the changeto the Eighth Revision. The number of deaths in1967 coded to this cause by the Seventh Revi-sion was 48,314, and the number for 1968coded to the comparable group of causes by theEighth Revision was 43,840 deaths–a reductionof 4,474 deaths. Inasmuch as 8.17 percent ofthe 48,314 deaths in 1967 is 3,947 deaths, thedifference between 4,474 and 3,947 deaths (527deaths) is the estimated maximum number thatmay be attributed to an actual lowering of thedeath rate for this group of causes.

A more precise measure of the true declinein mortality among infants from these causes

Seventh Revision

I


in 1966

(1) (2)

All causes ... . .. ... ... . .... ... .. .. .. .. ... .. . ... .. .. . ... .. OOl.E999

r

1,863,149

Certain diseases of early infancy .. . .. ... .. . .... .. . ....76 O-776 51,644Pneumonia of newborn .. .... . . ..... .. .. .. .. .. . ... ... .... . .. ...763 2,477Diarrhea of newborn ... . .. .... . .. .... ... ... ... . ... .. . .... . . .....764 250Remainder of Certain diseases of earlyin fanc~ ... .. .... .. ... . . .... .. ... ... ... . ... .. . ... ..76 O.762.765.776 48,917

Other causes .... .. ... .. . .... .. . .. .. .. ... .. ... . ... .. . ... .. ... ... Residual 1,811,505

may be obtained by applying the comparabilityratio of 0.9183 to the 1967 infant mortality ratefrom these causes (1,3 71.0 deaths per 100,000live births). Multiplying the rate of 1,371.0 by0.9183 gives a death rate of only 1,259.0 per100,000 live births. The difference between the1968 rate (1,248.2 deaths per 100,000 Iivebirths) and the adjusted 1967 rate (1,259.0) is10.8, constituting a reaI decrease in mortality ofonly 0.86 percent.

As stated above under section 5, “Influenza .and Pneumonia,” the reduction in the assign-ment of deaths to the Eighth Revision titleCertain causes of mortality in early infancyreflects primarily the change in classification to .provide that only diseases specific to the new-born (e.g., hemolytic disease of the newborn) beincluded under this title, and that conditions notdifferent from those classified outside the peri-natal classification, such as pneumonia and diar-rhea, be excluded.

About 2,232 of the 2,477 deaths assigned bythe Seventh Revision to Pneumonia of newborn(ICD No. 763) were assigned by the Eighth Revi-si o n to Pneumonia (ICDA Nos. 480-486).Tabulations for the age group under 1 year ofdeaths assigned to this latter cause by the EighthRevision give the number of infants dying frompneumonia. Tabulations are also available

.Eighth Revision

Estimated number ofdeaths in column (2)that went to Certain

causes of mortality inearly infancy (ICDA

NOS. 760-769.2,769.4-772,774-778)

(3)

47,425

46,706191

5

46,510

719

Estimated number ofdeaths in column (2) .


(4)

1,815,724

4,9382,266

245

2,407

1,810,786

42

showing the number of these deaths thatoccurred at ages under 28 days.

About 233 of the 250 deaths that wereassigned by the Seventh Revision to Diarrhea ofnewborn (ICD No. 764) were assigned by theEighth Revision to Enteritis and other diarrhealdiseases (ICDA Nos. 008, 009). As for thepneumonias, tabulations of deaths for the agegroup under 1 year assigned to Enteritis andother diarrheal diseases (ICDA Nos. 008, 009)give the number of infants dying from thiscause. Tabulations are slso available showing thenumber of these deaths that occurred at agesunder 28 days.

The estimated 2,407 deaths that wereassigned by the Seventh Revision to Certaindiseases of early infancy (other than Pneumoniaof newborn and Diarrhea of newborn) and werenot assigned by the Eighth Revision to thecomparable title Certain causes of mortality inearly infancy were distributed among EighthRevision titles as follows:

Title and category numberNumber of

deaths

Septicemia ......... ................................................W8Congenital anomalies ..................................740-759Symptoms and illdefined conditions ..... .....78O-796Other avitaminoses and nutritionaldeficiencies ...................... ............260,261,263-269All other endocrine and metabolicdiseases.........251,252,256-258,270-272,273.1 -279Other dismses of respiratorysystem ................ ...........501-508,512,514-516,51 9Diseasesof the skin and subcutaneoustissue ...........................................68O~%.6W7O9

Other causes.......... .................. .................... ..... . . .

555288226

328

82

206

82

639

An estimated 719 deaths not coded by theSeventh Revision to Certain. diseases of earlyinfancy were shifted from a number of cate-

gories to the Eighth Revision title Certain causesof mortality in early infancy (ICDA Nos.760-769.2,769.4-772, 774-778).

Among these were an estimated 203 deathsthat in the Seventh Revision were assigned toOther diseases of heart (ICD Nos. 430-434). Thischange resulted from the transfer of such termsas “cardiac arrest of newborn” and ~’cardiacrespiratory arrest of newborn” from ICD No;433.0 of the Seventh Revision to the EighthRevision category number 778.9, under Otherconditions of fetus or newborn (ICDA No. 778).

Also among these 719 deaths were an esti-mated 158 deaths that in the Seventh Revisionwere assigned to Symptoms, ill-defined, andunknown causes (ICD Nos. 780-793, 795). Thisshift resulted primardy from the transfer ofterms under the category of the Seventh Revi-sion for ilI-defined conditions to the EighthRevision title Other conditions of fetus or new-born (ICDA No. 778). Deaths to newbornsresulting from hemorrhage of a number of sites(e.g., liver and kidney) that by the SeventhRevision were coded to categories other thanHemorrhagic disease of newborn (ICD No. 771)were transferred to this titIe by the EighthRevision (ICDA No. 778.2).

Data from the comparability study based ondeaths in 1966 show that transfers from theSeventh Revision titie Certain diseases of earlyinfancy (ICD Nos. 760-776) to the Eighth Revi-sion titIe Congenital anomalies (ICDA Nos.740-759) resuIted in a decrease of 315 deathsassigned to the former cause; and transfers fromthe Seventh Revision title Congenital malforma-tions (ICD Nos. 750-759) to Certain causes ofmortality in early infancy (ICDA Nos.760-769.2, 769.4-772, 774-778) resulted in anincrease of 148 deaths to the Iatter cause.

43

7. DIABETES

There were no serious breaks in continuityfor mortality statistics for Diabetes mellitus(ICDA No. 250) between 1967 and 1968. The

IMELLITUS

comparability ratio between the SeventhEighth Revisions is 0.9971 (appendix I).

and

Seventh RevisioriI

Eighth Revision

Number ofEstimated number of Estimated number of

Cause of death and category number deathsdeaths in column (2) deaths in column (2)that went to Diabetes that went to

in 1966mellitus (ICDA No. 250) other causes

(1) (2) (3) (4)

All causes ... . ... ... . ... .. ... . .. .. . .... . . ... . . .. .. . ... .. . 001-E999 1,863,149 34,496 1,828,653

Diabetes mellitus . .. ... ... .... .. . ... . .. ... . ... .. .... ... ... . . .. . . ... . .260 34,597 33,870 727Other causes ... ... .... ..... . . .... . .. .. . ... .. . . ... .. ... . .... . . .. Residual 1,828,552 626 1,827,926

.

I I 1 .

8. ARTERIOSCLEROSIS

As shown in the table below, the break intrend between the Seventh and the Eighth Re-vision, introduced for data year 1968, forArteriosclerosis (ICDA No. 440), was appre-ciable, resulting in a comparability ratio for theSeventh and Eighth Revisions of only 0.8963(appendix I).

The three largest components of the esti-mated 6,824 deaths in the 1966 comparabilitystudy that were assigned by the Seventh Revi-

sion to General arteriosclerosis (ICD No. 450)but were not reassigned by the Eighth Revisionto the comparable title Arteriosclerosis (ICDANo. 440) were as follows: (1) an estimated2,418 deaths that were transferred by the EighthRevision to the list title A1l other diseases ofarteries, arterioles, and capillaries (ICDA Nos.442-444, 446-448); (2) an estimated 1,938deaths that were transferred from the four-digit

.

Seventh Revision title General arteriosclerosis,

Seventh Revision I

.Eighth Revision

Estimated number ofNumber of deaths in column (2)

Estimated number of

Cause of death and category number deaths that went todeaths in column (2)

that went toin 1866 Arteriosclerosis (ICDA

No. 440)other causes

(1) (2) (3) (4)

All causes ... . ... ... ... . ..... . . .... . . .. . .. .. .. . . .. .. . ... . 001 -E999

F

1,863,149 34,873 1,828,276

General arteriosclerosis . ... .. .. .. .. . ... . .. .. .. . ... . . ... . ... .. ... ..45O—.

38,907 32,083 6,824Other causes . .... . ... ... .... .... .. .. ... . .... . . ... . .... .. . ... . .. Residual 1,824,242 2,790 1,821,452

44

..

with mention of gangrene as a consequence (ICDNo. 450. 1), to the Eighth Revision title Arterio-sclerotic gangrene (ICDA No. 445.0); and (3) anestimated 1,209 deaths that were transferredfrom General arteriosclerosis (ICD No. 450) toChronic ischemic heart disease (ICDA No. 412).

The reason for the transfer of the 2,418deaths from General arteriosclerosis to All otherdiseases of arteries, arterioles, and capillaries(ICDA Nos. 442-444, 446-448) is that theEighth Revision provides that if Arteriosclerosis(ICDA No. 440) is reported as the underlyingcause of any condition in ICDA Nos. 443,444,and 446 , the combination of arteriosclerosisand the ,condition is to be coded, and the deathassigned to the condition.

As mentioned above in section 1, “Diseasesof Heart,” the estimated 1,209 deaths weretransferred from General arteriosclerosis (ICD

No. 450) to Chronic ischemic heart disease(ICDA No. 412) because the Eighth Revisionprovides that if ArtenoscIerosis (ICDA No. 440)is jointly reported with Chronic ischemic heartdisease (ICDA NQ. 412), the combination iscoded, and the death is assigned to Chronicischemic heart disease (ICDA No. 412).

The major shift in the opposite directionfrom the changes described above was thetransfer of an estimated 1,498 deaths from theSeventh Revision title Functional disease ofheart (ICD No. 433) to the Eighth Revision titIeArteriosclerosis (ICDA No. 440). As alsomentioned under section 1, “Diseases of Heart,”this resulted primarily from the dropping in theEighth Revision of the priority given in theSeventh Revision to Functional disease of heart(ICD No. 433) over General arteriosclerosis (ICDNo. 450).

9. BRONCHITIS, EMPHYSEMA, AND ASTHMA

All Bronchitis, Emphysema, and Asthma(ICDA NOS. 490-493)

The comparability ratio for this group ofcauses between the Seventh and Eighth Revi-sions is 1.0034 (appendix I). Although this ratiois close to 1.000, the corresponding factors forthe three components of this group of diseasesvary considerably from 1.000. Before describing

the classification changes and trends of thedeath rates for each of these three components,the reasons for the introduction by the UnitedStates for data year 1969 of a fourth componentwiIl be given. This new four-digit component isChronic obstructive lung disease (ICDA No.519.3).

The assignment of deaths by physicians andother medical certifiers to the general title

Seventh Revision!

Eighth Revision

IEstimated number of

Number of deaths in column (2)Estimated number of

Cause of death and category number deaths that went to Bronchitis,deaths in column (2)

in 1868that want to

emphysema, and asthma[ICDA NOS. 49043)

other causes

(1) (2) (3) (4)

All causes .. .. .. .. . .... . . .... . .. ... . .. ... . .. .. .. .. .. .. . .. OQ1-E999 1,s3,149 29,841 1,833,X)8

Comparable causes .. ... . . ... . ... ... .. . .. ...241 ,501,502,527.1 29,740 28,602 1,138Asthma .. .. .. ... . .. ... . .. ... . . .... .. . ... . . .... .. .. .. .. . ... . .. .. . .. .... . .241 4,324 4,089 235Bronchitis, chronic and unqualified ... . .. ... . . ....501.502 5,164 4,884 270Emphysema without mention of bronchitis ... ...527.1 20,252 19,619 633

Othar muses............ ......................... ........... ... Residual 1,833,408I

1,239I

1,832,170

45

“chronic obstructive lung disease” (COLD) or to“chronic obstructive pulmonary disease”(COPD) did not start to become fashionableuntil the late 1960’s or early 1970’s.

For the years the Seventh Revision was inuse (1958-6 7) “chronic obstructive lung disease”was indexed as an inclusion term under Other(ICD No. 527.2), which in turn was a four-digitcode under Other diseases of lung and pleuralcavity (ICD No. 527). The number of deathsattributed to ICD No. 527.2 remained almoststable between 1958 and 1967, increasing onlyfrom 2,482 for 1958 to 2,596 for 1967.

It should be stressed that there were a con-siderable number of other terms in addition to“chronic obstructive lung disease” that wereindexed as inclusion terms under ICD No. 527.2.Some, but not all of these terms, are shown inthe section below, extracted from the Inter-national Classification of Diseases (Seventh Revi-sion):

Acute oedema of lung

}

without mention of

Acute pulmonary oedema heart disease NOS or

Hernia of lung heart failure

Mediastinitis ~acute) (chronic)Stenosis of:

bronchustrachea

Ulcer of bronchus

This title excludes acute oedema of lungwith mention of any condition in 434.4 or782.4 (434.2) and chronic or unspecifiedpulmonary oedema (522).

Nevertheless, as stated above, there were only2,482 deaths for 1958 and 2,596 deaths for1967 assigned to ICD No. 527.2.

During the late 196 O’s persons involved in

cod ing t h e medical section observed that“chronic obstructive lung disease” was appearingwith increasing frequency on the deathcertificate. By this time the Eighth Revision had;ilrcady I)ccn adoptccl by the 1965 international(l)nlcrencc Ior the Revision of the InternationalClassification of Diseases. The Index to the

Eighth Revision (Volume 2) provided thatchronic obstructive lung disease be assigned,again along with a number of other inclusionterms, to Other diseases of lung (ICDA No.519.2). The National Center for Health Statis-tics, to separate out of ICDA No. 519.2 deathsattributed to chronic obstructive lung disease,introduced with data year 1969 the followingspecial four-digit category: *Chronic obstructivelung disease (ICDA No. 519.3) (which is markedwith an asterisk that indicates it was introducedindependently by the United States). As data forlater years became available it was found thatthe number of deaths attributed to this causeincreased rapidly, rising from 2,704 deaths for1969 to 6,321 deaths for 1971.

To provide that deaths wouId not beassigned to *Chronic obstructive lung dzkease(ICDA No. 519.3) if a more specific diagnosissuch as chronic bronchitis, emphysema, orasthma also appeared on the death certificate,the coding procedures were updated for 1971and 1972 data years in accordance with the link-ages below:’

*519. 3 Chronic obstructive lung disease with-out mention of asthma, bronchitis,or emphysema

Excludes conditions in 519.3 with condi-tions in:

.

490491492493

But the

Bronchitis (491 )(Chronic bronchitis)(Chronic bronchitis) (491)(Emphysema) (492)(Asthma) (493)

+

limitation irriposed by these linkage .provisions did not rdter the upward trend in thenumber of deaths assigned to *Chr6nic obstruc-tive lung disease without mention of asthma,bronchitis, or emphysema (N3DA No. 519.3).The number of deaths assigned to ICDA No.519.3 increased from 6,321 for 1971 to 11,334for 1973.

This special four-digit subdivision for* C}l rOn ic obstructive Iuhg diwasc withoutmcnti(ln of asthma,(51g.3) includes the

bronchitis, or emphysemafollowing inclusion terms:

46

*519.3 Chronic obstruction(disease):

airway (s)lung(s)

)

Withoutpulmonary mention ofrespiratory

only asthma (493)

Obstructive (chronic):bronchitis

airway disease(chronic) (491 )

broncho-pulmonaryemphysema (492)

diseaselung diseasepulmonary disease }respiratory disease

Medical textbooks for decades have included asection on “chronic obstructive lung disease,” a

. title that embraces a number of clinical syn-dromes of varying etiology and pathology, withthe common feature of increased hindrance tothe flow of air out of the lungs resulting from an

. in trapulmonary condition—including asthma,bronchitis, and emphysema. But until recentyears physicians almost always entered on thedeath certificate a specific diagnosis such asemphysema, bronchitis, or asthma instead ofthis generalized term.

Rarely in the history of classification ofdiseases has such a reversal as this one beenobserved-with an increasing number of medicalcertifiers entering on the certificates a grouptitle for a complex of diseases instead of aspecific diagnosis.

It is believed that the general term “chronicobstructive lung disease” is most often used bymedical certifiers when they are in doubt as towhether the specific underlying cause of deathwas emphysema or chronic bronchitis.

.

Major Components

Chronic and tmqualijiied bronchitis (ICDANos. 490, 491).–Based on the sample of deathsin 1966 coded by the Seventh and Eighth Revi-sions, there were 5,484 deaths assigned to thiscause by the Eighth Revision and 5,164 deathsassigned to the comparable title (ICD Nos. 501,502) by the Seventh Revision, giving a ratio of1.0620 (appendix I and table below). The deathsnot assigned by the Seventh Revision to I(ZDNos. 501, 502 that were assigned by the EighthRevision to ICDA Nos. 490, 491 were trans-ferred from a number of Seventh Revision titlesincluding Asthma (ICD No. 241) and Bronchi-ectasis (ICD No. 526).

An estimated 41 deaths assigned by theSeventh Revision to Asthma (ICD No. 241) weretransferred by the Eighth Revision to Chronicbronchitis (ICDA No. 491). By the SeventhRevision only that asthma not indicated asallergic with mention of bronchitis (acute orchronic) was considered to be linked withbronchitis: that is, a death attributed to such acombination of causes was assigned to bronchi-tis. But by the Eighth Revision aI1ergic asthma,as well as asthma not indicated as allergic, whenselected as the presumptive underlying cause ofdeath, is linked with bronchitis: that is, thedeath is assigned to bronchitis.

About 132 of the deaths assigned by theEighth Revision to Chronic bronchitis (ICDANo. 491 ) were assigned by the Seventh Revisionto Bronchiectasis (ICD No. 526). In the SeventhRetision bronchiectasis was linked with mention

Seventh Revision Eighth Revision.

I Estimated number of I

Number of Ideaths in column (2) Estimated number of

Cause of death and category number daathsthat went to Chronic deaths in column (2]

in 1966and unqualified that went to

bronchitis (1CDA Nos. other eausas

I 490,491 )(1) (2) (3) (4)

All causes..................... .. .......... .............. 00T -E999 1●@33,149 5,464 1,857,665

Bron&itis, chronic and unqualified .................5Ol ,502

—

5,164Other causes

4,851 313..................... .... .......................... Residual 1,657,985 633 1,8!57,352

47

r-.Seventh Revision Eighth Revision


Cause of death and category number deathsdeaths in column (2) deaths in column (2)

that vmnt to Emphysema that want toin 1966

(ICDA(:;. 492) other causes

(1) (2) (4)

All ‘causes ... . .. ... . .. . ... .. . .... .. .. .. . ... ... . .. . . ..... . 001 -E999 1,863,149 1,841,799— .-..

Comparable causes . .. ... . .. .. ... .. . .... . .... . . ... .. .. ....241.527.1.-—--

24,576 -20,980 3,596Asthma .. ... . ... .. .. ... .. ... .... .. .. .. .. .... . .... . .. .. .. .. .... .. . ... . ...24l 4,324 1,425 2,899Emphysema without mantion of bronchitis ....527.1 20,252 19,555 697

Other causes . ..... .. . .. . ... . .. .. . ... .. . .... . ..... .. ... . .. . ... . . Rasidual 1,838,573 370 1,838,203

1~h~ is the ~itle to ~hi~h deaths in tables I and 2 were assigned during 1950-67, when the sixth and Seventh Revisions were in use..

“of any condition under Bronchitis (ICD Nos.500-502); but this linkage was dropped by theEighth Revision. For example, the deaths de-scribed by the following entries were classifiedby the Seventh Revision to Bronchiectasis (ICDNo. 526) and by the Eighth Revision to Chronicbronchitis (ICDA No. 491):

I (a) Chronic bronchitis and bronchiectasis(b)(c)

I (a) Bronchiectasis(b) Chronic bronchitis(c)

Actually, as indicated above, all 132 deaths wereas;igned to Chronic bronchitis by the EighthRevision.

Emphysema (ICDA No. 492). –There were21,350 deaths assigned by the Eighth Revisionto Emphysema (ICDA No. 492) and 20,252deaths assigned by the Seventh Revision to the

nearly comparable title Emphysema withoutmention of bronchitis (ICD No. 527.1), giving aratio of 1.0542 (appendix I). As shown in thetable above, this increase of about 5.42 percent

.

in the deaths assigned to emphysema resulted Iprimarily from the transfer of about 1,425deaths that were assigned by the Seventh Revi-sion to Asthma (ICD No. 241).

By the Seventh Revision asthma was notlinked with emphysema; while by the EighthRevision it is linked with emphysema: that is, ifasthma is the presumptive underlying cause andthere is mention of emphysema on the certifi-cate, the death is assigned to emphysema.

Applying the factor 1.0542 to the 1967death rate for emphysema (10.6) raises it to11.2–the level it would have reached if thedeaths in 1967 had been coded by the EighthRevision.

Asthma (ICDA No. 493).–Based on the .sample of deaths in 1966, there were only 3,007deaths assigned to this cause by the Eighth Revi-sion but 4,324 deaths assigned to it by the

—— —. .— . —-. ,.Seventh Revision

.1Eighth Revision

—— .—— ... ——— — ...-— ..---— — —----- . . . --- . —-—-

Number of IEstimatad number of Estimated number of

Cause of death and category number deathsdeaths in column (2) deaths in column (2)that went to Asthma

in 1886that went to

(ICDA No. 493) other causes

(1) I (2) I (3) I (4)

All causes . ... .. ... . .. . ... .. . .. . .. .... .. .... .. . ... .. .. ... 001-E999 7,863,149

Asthma . .... .. . .... .. ... .. . .. ... . .. ... .. ... ... . .. .. . . .... .. .... ... .... ....24l 4,324Other causes ... ... .... .. ..... .. . .. ... .... .. . ... . .. .... . . .. .. .. . Residual 1,858,825 -++--- :;

48

Seventh Revision, giving a ratio of 0.6954. An estimated 60 deaths assigned by the(Appendix I.) Seventh Revision to Asthma were assigned by

As stated above, an estimated l,4250f the the Eighth’ Revision to Acute myocardial infarc-1,701 deaths that were assigned to asthma by tion (ICDA No. 41 O), with the greatest numberonly the Seventh Revision were transferred to of them (49 deaths) going to the four-digit titleEmphysema (ICDA No. 492) as a result of the Acute myocardial infarction, without mentionprovision in the Eighth Revision for linkage of of hypertensive disease (ICDA No. 410.9).asthma with emphysema.

.

.

10. CIRRHOSIS OF LIVER

As shown in the table below, there was no between 1967 and 1968. The comparabilityserious break in comparability of mortality sta- ratio is 1.0055 between the Seventh and Eighthtistics for Cirrhosis of liver (ICDA No. 571) Revisions (appendix I).

8ewmth Revision I Eighth Revision

Number of IEstimated number of Estimated number of

Cause of death end category number deetlwdeaths in column (2) deaths in oolumn (2)thet went to Cirrhosis that want to

in 1866 of liver (ICDA No. 571) other causes(1) (2) (3) I (4)

+All causes.............................. .......... ....... 001 -E988 1,883,149 I 26,839 I 1,836Jll O

—.Cirrhosis of liwr ................... ............ ...... ................58l

II26,692 26,203 489

Without mention of alcoholism ............ .............58l.0 17,320 16,962 358With alcoholism ...... .............. ..................... .... ....58l.l 9,372 9,241 131

*Other causes............ ................. ...... .. .............. Residual 1,836,457 636 1,835,821

49

11. SUICIDE

The comparability ratio for Suicide (ICDA or purposely inflicted (ICDA Nos. E980-E989)Nos. E950-E959) between the Seventh and had been assigned by the Seventh Revision toEighth Revisions was 0.9472 (appendix I). Suicide. Assignments to this new title are rdsoAbout 31 percent of the 3,059 deaths in 1966 discussed under Accidents (ICDA Nos. E8001-assigned by the Eighth Revision to the new cate- E949) on page 36 and under Homicide (ICDAgory Injury undetermined whether accidentally Nos. E960-E978) on page 52.

=Seventh Revision I Eighth Revision

Number ofEstimated number of Estimated number ofdeaths in column (2)

.

Cause of deeth and category number deathsdeaths in column (2)

thet went to Suicidein 1856

that want to[ICDA N073;960-E959) other ceuses

(1) (2) (4)

.All txU.WS . . . ... .. . .. ... ... .. .. .. .. .... . ... .. .. ....0..... 001 -E989 1,863,149 20,158 1,842,991

Suicide ..... .. .......................................E963,E970-E979 21,281 20,046 1,23%Suicide by poisoning ................................ E970-E973 5,588 5,192 398Suicide by hanging end strangulation ... ..... ........ E974 2,=3 2,825 38Suicide by firearm end explosive ............ ........... E876 10,407 10,072 335Suicide by all other means.. ... E963,E975,E977-E979 2,423 1.957

Other musm .... .............. ................................. Flesiduel 1,841,S8 112 1,841,756

12. CONGENITAL ANOMALIES

Based on the sample of 1966 deaths codedby both revisions, there were about 18,529deaths assigned by the Eighth Revision to Con-genital anomalies (ICDA Nos. 740-759) and18,158 deaths assigned by the Seventh Revisionto the most nearly comparable title Congenitalmalformations (ICD Nos. 750-759), giving acomparability ratio of 1.0204 (appendix I).

If the 17,328 deaths in 1967 were increasedby this factor, the adjusted figure would be17,681. The difference between the figure for1968 (16,793) and the adjusted figure for 1967(17,681) is 888 deaths. But this reduction of888 deaths also reflects fewer infants at riskresulting from the decrease in live births in 1968as compared with the number in 1967.

.More precise annual measures of the true

decline in mortality maybe obtained by Iirnitin,gconsideration to deaths occurring at ages under1 year from Congenital anomalies per 100,000 .live births. (About 66 percent of the totalnumber of deaths assigned to this cause occur atages under 1 year.)

Based on the dual-coding study of deathsoccurring in 1966, an estimated 12,644 infantdeaths were assigned by the Eighth Revision toCongenital anomalies (ICDA Nos. 740-759) and12,200 infant deaths were assigned by theSeventh Revision to Congenital malformations(ICD Nos. 750-759). Use of the comparabilityratio 1.036 (obtained by dividing the 12,644deaths by the 12,200 to adjust the 196’7

50

8ewnth Revision


(1)

All CSUSSS ... .. . ... . .. ... .. .. .. .. . ... .. . .. .. . .. ... . ... . .. 001-E989

Congenital malformations ...............................750-7588pina bifide and meningocele ...............................75lCongenital hydmcephalus and other congenitalmalformations of nervous system and senseorgens...........................................................752,753Congenital malformations of circulatory system ..754Other congenital malformations .............75O.755-758

Mental defickn~ ............................ .......................325

Other causes................................................... Residual

Number ofdeathsin 1886

(2)

l,m3,149

18,1581,151

1,7569,0206,231

511

1,844,460——

Eighth Revision


that went to Congenitalanomalies (ICDA Nos.

740759)(3)

1&529

17,4531,125

1,6558,8195#653

258

620

Estimated number ddeaths in column (~)

thet went toother. causes

(4)

1,644,620

705s

2!i5

1,843,660

infant mortality rate for congenital malfor- risk of dying from this group of causes at agesrnations (330.4 per 100,000 live births) to under 1 year.the level it would have had if the Eighth Revi- One -“of the changes involving congenitidsion had been used for 1967 results in an anomalies was the transfer of about ’256 of theadjusted rate of 342.3. The difference between 511 deaths assigned by the Seventh Revision tothe 1968 rate (315.6 per 100,000 live births) MentaI deficiency (ICD No. 325) to Down’s dis-and the adjusted rate for 1967 is 26.7 deaths per ease (ICDA No. 759.3). These transferred deaths100,000 live births, constituting a real decrease were assigned by the Seventh Revision to theof 7.,8 percent between 1967 and 1968 in the four-digit subtitle Mongolism (ICD No. 325.4),

51

13. HOMICIDE

There was no sizable disruption in the com-parability of statistics for Homicide (ICDA Nos.E960-E9 78) with the introduction of the EighthRevision (with a comparability ratio of 0.9969)(appendix I).

In the dual-coding study of deaths occurringin 1966 it was found that about 52 of the 211deaths that were not reassigned tcs homicidewere transferred to the new Eighth Revision title

Injury undetermined whether accidentally orpurposely inflicted (ICDA Nos. E980-E989).Assignments to this new title ate also discussedunder Accidents (ICDA Nos. E800-E949) onpage 36 and under Suicide (ICDA Nos. E950-E959) on page 50. Deaths assigned by theSeventh Revision to homicide constituted onlyabout 2 percent of all deaths assigned to thisnew Eighth Revision title.

.



Cause of death and category number deathsdeeths in column (2) deaths in column (2)

that went to Homicidein 1866

that want to(ICDA NOS. E960-E978)

(1) (2) (3)other causes

(4)——

All causes .. ... .. .. ... . . ..... . .. ... . .. . .. .. ... .. . ... ... . . 001 -E988 1,s3,149 ! 11,570 1,851,679

Homicide . . .... . .. .. .. ... ... .. ..... ... ... . .. ... . . ...~64.E9W.E985 11 ,6CK 11,395 211Assault by firearm and explosive .. ... . . .... . .. .... .. .. . E981 6,856 6,773 ,82Assault by cutting and piercing instruments .. . ... E982 2,330 2,300 30Assault by other means .. . .. ... . .... . .. ... E864.E98O.E983 2,122 2,023 99Injury by intervention of police . . .... . .. .. . ... .... .. .. . E964 298 298Execution ... .. . ... .. .. ... .. ...... . . .. .. .. .. .. . .. .. .. ... .. .. .. .. . ... E985 1 1

Other causes .. .. .... .. . .... . ..... . .. . .. . .. ... . . .. .. .. .... .. ... . Residual I 1,851,543 [ 175 I 1,851,3681 I..— .~

14. NEPHRITIS AND

The dual-coding study of deaths occurring in1966 showed that an estimated 10,227 deathswere assigned to Nephritis and nephrosis (ICDANos. 580-584), whereas the number assigned bythe Seventh Revision to this title (ICD IVos.590-594) was 11,540 deaths, giving a compara-bility ratio of only 0.8862 (appendix I). If the10,941 cleaths in 1967 were decreased byapply ins this factor, the acljusted figure wouldbe 9,696, giving a reduction between 1967 and1968 (J( only 4.0 pcrccnt.

Bccausc of the incrciwc in the population, amow precise mc;u+urc of the atnollnt of reduc-

tion

NEPHROSIS

in mortality may be obtained by applyingthe comparability ratio to the death rate ratherthan to the number of deaths. Using theadjusted death rate for 1967 (4.9 deaths per100,000) gives a reduction between 1967 and1968 of 4.1 percent.

As shown in the table below, an estimated1,476 of the 10,376 deaths that were assignedby the Seventh Revision to Chronic andunspecified nephritis and other renal sclerosis(ICI) Nos. 592-594) were not rmssigncd hy theEighth Revision under Nephritis and nephrosis(IC1)A Nos. 580-584) (appentlix I). :\n examina-

.

LJL

-.. _____ ——



(1)

Estimatad number ofNumber of deaths in column (2)

Estimated numbar of

deaths that want to Nephritisdeaths in column (2)

in 1866that want to

and nephrosis (ICDANOS. 580-584)

other causes

(2) (3) (4)

All causes.................. .................. ........... 001-E999 1,663,149 10,227 1,8452,922

Nephritis and nephrosis ...... .............................590-594----

11,540 9,955Acute nephritis

1,&T................ ................... ................ ..590 485 462

Naphritis with edama, including nephrosis ...........591 679 593 “ s%Chronic and unspecified nephritis and other renal*lerosis ........................................ ................592.594 10,376 8,9CK) 1,476

Other @urns ................................................... Residual I 1,851,609 j 272 I 1,851,337

~ion of the major components of these 1,476deaths shows that “they were assigned by theEighth Revision as foIIows: (1) an estimated 986of the deaths were transferred to the list titleOther diseases of urinary system (ICDA Nos.591, 593, 595-599), and (2) an estimated 152deaths were transferred by the Eighth Revisionto Hypertensive renal disease (ICDA No. 403). Itshould be noted that the subgroup of categoriesunder the title “Other diseases of urinarysystem” does not include Infections of kidney(ICDA No. 590).

Association of Hypertension with Nepinitisand nephrosis. —About 84 percent of all deathsattributed to Nephritis and nephrosis (ICDANos. 580-584) were assigned to chronic andunqualified nephritis (ICDA Nos. 582, 583).These conditions are frequently associated withhypertension. The percentage of deathsattributed to category numbers 582 and 583 wassomewhat higher for the population of racesother than white (85.9 percent) than for thewhite population (83. 1 percent).

Physicians report that since the kidney isfrequently involved in forms of hypertension, itis often difficult to be sure of the differencebetween primary change causing the hyper-tension and secondary damage because of thehypertension.

Although hypertension may complicate anyform of renal disease, clinical histories show thatit is particularly common and severe in glomer-ular disease.g

Multiple-cause data based on a sample ofdeaths in 19559 show that for the white popula-tion hypertension was reported as a contribu-tory condition in 12.7 percent of aI1 deathsassigned to Chronic and unspecified nephritisand other renal sclerosis (ICD Nos. 592-594).The corresponding percentage for the popula-tion of races other than white was even higher–18.1 percent. It is believed that figures forhypertension as a contributory condition ofnephritis and nephrosis are underreported,particulady for the population of races otherthan white.

It should be noted that the coding proce-dures in effect with the Eighth Revision provide,as did the procedures in effect with the SeventhRevision, that conditions of renaI damage classi-fiable to nephritis and nephrotic syndrome(ICDA Nos. 580-583) be selected as the under-lying cause of death when the renal conditionwas a consequence of Essential benign hyper-tension (ICDA No. 401). Within this fact may befound an exphmation of why the mortality fromNephritis and nephrosis continues to be higherfor the population of races other than white, forit is well known that this population is afflictedrelatively more frequently with hypertensionthan is the white population. Consistent withthis prevalence differential by color, hyper-tension is also reported as the underlying causeof death relatively more frequently for thepopulation of races other than white than forthe white population (figure 1).

53

20,0

19.0

18.0

17.0

16.0

16,0

14.0

13.0

z0 12.0~

<

: ,,0

0“

ii mo

g

c 9.0

%’

6.0

5.0

40

3.0

1-

I

1.0 ~

19s0 1955 1960 1965 1970

YEAR

[For 1968 and 1969 rates arc based.. deaths amiwcd 10 catcgmy n.mbefi 400.401,403 of the Eighth Rem”rio. International Clamificati.n of Duemes, Adapted foruw i. the U.it.d SWC.; and fw 1950.67 they are based on deaths zmigncd tocawgmy numhcrs 444-447 of the Sixth md .%cnth Redsbns, adopted in 1948and 1955, respectively. Rates WC? adjuredby the dime! method, using the totalpopulation of, the United States !n 1940 as the standard population. ‘W p.pu.Iat mm u clasmied m the foUowW agc soups (in years): under 1, 1-4, 5.14,15.24, 25.S4, 35-44,45.54,55.64,65.74, 75-64,85 and over.]

Figure 1. Age-adjusted death rates for Hypertension, by colorand sex: United State% 1950*9..

Except for the break in continuity of mor-tality statistics between 1957 and 1958 (withthe introduction of the Seventh Revision) andthe Icsser lwcak bctwecm 1967 and 1968 (withthe introduction of the Eighth Revision), them(>rtalit}’ trend for hypertension as the under-lyi]lg cause ()[ dcaLh was clearly downward

during 1950-69. The comparability ratio forhypertension ‘between the Sixth and SeventhRevisions was 1.33, resulting primarily from thedropping of the preference given by the SixthRevision tq Arteriosclerotic heart disease so-clescribed (ICD No. 420.0) over Other hyper-tensive disease (ICD Nos. 444-447 ).5 Betweenthe Seventh and Eighth Revisions the compara-bility ratio was 0.8199.

An estimated 1,238 deaths assigned by theSeventh Revision to Hypertension with arterio-Iar nephrosclerosis (ICD No. 446) were trans-ferred by the Eighth Revision to titles otherthan Hypertension (ICDA Nos. 400, 401, 403). “About 899 of these 1,238 deaths were trans-ferred to Chronic ischemic heart disease with orwithout cardiovascular disease with hypertensivedisease (ICDA No. 412.*1). “

The transfer of these 899 deaths constituteda reinstatement of the Sixth Revision prioritythat Arteriosclerotic heart disease so described(ICD No. 420.0) had over Hypertension witharteriolar nephrosclerosis without mention ofheart (ICD No. 446). This priority given to ICDNo. 420.0 was dropped .by the. coding rtdesintroduceci with the Seventh Revision for 1958.It should be noted that the Seventh Revisionalso eliminated the words “without mention ofheart” from the Sixth Revision title corre-sponding to ICD No. 446: thus the SeventhRevision title is reduced to Hypertension witharteriolar nephrosclerosis (IC D No. 446). Asused with the Sixth Revision, the words “with-out mention of heart” were not to be inter-preted literally but were defined to mean ●

without mention of only the following types ofheart disease: Other myocardial degeneration(ICD No. 422), Functional disease of heart (ICDNo. 433), and Other and unspecified diseases of 4

heart (ICD No. 434). In other words the phrasewas not to be taken to mean “without mentionof coronary heart disease.”

Compari.mn of mortality from Infections ofkidney and from Nepkrz”tis and ncplzrosis.,–Anumber of researchers have called attention tothe fact that while the total death rate forNephritis and nephrosis decreased, the deathrate for infections of the kidney turned upward,at least until about the middle of the 1960’s.\Vatcrs10 states:

54



in 1866

(1)

-+

Estimated number ofdeaths in dumn (2)

that want toHypertension (ICDA Nos.

400,401 ,403)(3)

All C8USaS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r?l=r

001-E999 , ,

Other hypertensive diseasa...... ........................444447Hypertension with artariolar nephrosclerosis........446Essential hypertension and other hypertensivedisease without mention of haatt ....... ...444.445.447

Other muws ................... ................................ ResidualI

1,851,769I

693

In England and Wales age-specific deathrat es for nephritis and nephroses havedecreased while those for infections of thekidney have increased during the sameperiod (1949-65). This seems to be due atleast in part to a change in diaa~ostic termi-nology. The death rates for nephritis andnephrosis and infections of the kidney com-bined show a decrease in men at all ages andin women below the age of 65 years.Reasons for the increase in deaths recordedas from infections of the kidney include thepossibility that infection is more commonlysought for now that it is amenable to treat-ment, the increased number of cases comingto necropsy, and the association betweenanalgesics and renal disease.

In the United States, as in Engkmd andWales, the death rate for ‘Infections of kidney(ICDA No. 590) did rise throughout the 1950’sand the early 1960’s. This rise continued for1958 and the early years of the 1960’s, despitethe fact that with the introduction of theSeventh Revision for 1958 about 2 percentfewer deaths were assigned to Infections ofkidney than had been assigned to this title bythe Sixth Revision.4 But duriny the early sixtiesthe upward trend in the LTnited States for Infec-tions of kidney leveled off and then startec~downward (figures 2, 3A, and 3B).

The coding procedures in effect with theEighth Revision, introduced for data year 1968,result in the assignment of about 3 percent more


that wanttoother causes

(4)

1,853,818

2,7421,238

1,504

1,851,076

deaths to Infections of kidney (ICDA No. 590)than had been assigned to this cause by theSeventh Revision.

The transfer of 120 deaths from Otherdiseases of urinary system (ICD Nos. 601, 603,605-609) to the Eighth Revision titIe Infectionsof kidney (ICDA No. 590) is believed to reflectprimarily the transfer of a number of inclusion

10.0 ~

1.0 ! 1 I 1 I , , , # I I , , I , ( I1950 1935 1s60 1965 197C

YEAR

[For 1%S and 1969 rxcs arc bucd on d.adw =igned to category IIumfxr 590.[ tfw.%+tk RcuckwI I.tcrruti.nd Uun”fi..tkx+ .f~ecits,Adqxrdforcb.m theUnitd States; md for 1951.d7, &y arc &cd on d.zdm assigned to cucgotynumbc~ 600 of tie Sixth.and Seventh Rcviti.nu, adopted in 1948 xod 1955,WXCtlVCf,Y. ktm were dJualcd by the direct mahal, wing the total populn;ionof h United St.Ics in 1940 x the jtandard popukio.. Tne pqxdation is cJA.fcd in the following qe groups (in yeas): under 1,14,5-14.15.24, 26.S4, 354,45.54, 5$6+, 65.74,75-84,85 and LWC,.I

Figure 2. Age-adjusted death rates for Infections of Kdney, by,color and sax: United States, 1951459.

!55

MALE200.0➤

I

1’ 85 and over

\

100.0

90.0

80,0

70.0

60.0

1~

75.84

\

/---<

50.0.“---’ ‘-*’

/-.040.0

t- /’--”

30.0 1- /--’”I 1“

,00I ●’-

‘[65.74 . . . . . . . . . . .

\. . . . . . . . . ...” ......$

. . . . ......%.. .....”. .... . ...”

...

...””..””

. . . . . .

10.0.. . . . .

9.01-

6.0

15564

7.0

6.0

/.)_. ”J’.,L

5.0. ..0’-”

“\\

4,0 t

I

i,1 I ;, t I I I1950 1955 1960 1%5 1970

YEAR

200,0

100,0

SOD

80.0

70.0

60.0

50.0

40.0

30.0

20.0

10,09.0

8.0

7.0

6.0

6.0

4.0

3.0

2.0

1.0

.9

.8

.7

.6

.5

.4

.3

.2

.!

FEMALE

\

1950 1955 1s60 19.35 1970

YEAf7I

I [ Fur I %8 and 19G!l r,tws arc 1,.s.,1 ,m dc.ths .LWWWI tt, C.,IWWY Inttmlmr 590 d the l,qhtl, 1<,,tw,>ttI,!!,r,,,,tr,,,t,d [1.xs;fwrir,n ,,f I>isa,ms. .l,hpl,.,1 p 1,,,. irt !/,, ( ,oilc,l S1,,!,,s,

I ;,!!!1 Ii, r 195 1.(,7 III,., .Irr 1,.,+.,1, III ,1..!!})$.,,$!<!,,.,1t,, c,I!eM<,r> numl,c., (,00 (,I I I,, s,.,1, .,,,1 ,sr, c.!II ltwiior. s,.Ik, pmdin 1948 md 1955, rcq,. uiw!y. Bemuse .f k,w frI’<ItImrws,,,, [<., ,,, . ,,,, ! ,1, (,,.,, f,,, , 1,,1,h,m ,!q,.(l i 14 ,(’., $.1

. .. ._, . . . . .... . . . --------....-. . .——.-.— - -.-.—..—. ..—

Figure 3A. Death rates for Infections of kidney among tha white population, by age and sex: United States, 1951-69.

.

.

.

.

.

2C0.(

lCQC

90.C

80.C

m.cm.c

60.0

40.0

3ma

zcka

10.0

9.0

ao

7.0

6.0

6.0

4.0

3.0

20

1.0.9

.8

.7

.6

.5

.4

.3

.2

.1

MALEzm.(

85 and over

\

/1f ~. 55.s4

.: /L .“ ,~-” ——

.: . .. . ... , ‘--,

/

.

‘“;>=

\

1950 1955 1960 1s65 1970

YEAR

100.(

90.(80.(

70.[

SO.(

SO.(

40.(

30.(

20.(

Io.cacs.a

7.a

6.a

s.a

4.a

3.a

20

1.0

.9

.s

.7

.6

.6

.4

.2

.2

.1

FEMALE

35 and over

1

.

\

,&~)/

2s.34

J , , I I I , I1950 1955 t 3aa 18s5 1970

YEAR

[For 1968 and 1%9 rates arc hated O. d.aths amignml to cmtcg.ry numk 590 of the .?<chtl, R.wirion I,ztcrnotion.1 Ckssific.ti,,,a ctftk-.$.s, .dd.ptdfor [k- ix lb<. L7nild S1.1.s:and for 1951-67 they arc bad on death, as,igncd to catcg.ry n.rnkr 600 oi the Sixth and Seventh R.rnions, adopml in 1948 and 1955, rcsp.ctivdy. Bcca.sc 0[ low fr.qu.mcics,ram arc not shonm for children agml 1.14 years.]

Figure 3B. Death rates for infections of kidney among tha population other than white, by aga and sax: Unitad States, 1951-69.

57

.—..—. —-..——- —..,!. ---- .--, . . .—----- -—. ,, ------- -— --—---— .—— -.—-——— . ------------ —

Seventh Revision


in 1866

(1) (2)

All causes ... ...... . .. .. . . .... . .. .. . .. . ... .. . .... .. .. ... . 001 -E999

h

1,%3,1 49

Infections of kidney . .... . .. .. .. .. ... .. . ... .. .. .. . .... ... .. ... ... ..6OO 9,498Other diseases of urinary systam .... ...601.603.605609 3,207

Other causes .. ... .. ..... . . ... . .. ... .. . ... .. . .... . .... .. ... ... .. Residual I 1,850,444

.——. . —1 -—- -––—

Eighth Revision—

Estimated number ofdeaths in colump (2)

Estimated number of

that went to 1nfectionsdeaths in column (2)

that went toof kidney ( ICDA

No. 590)other causes

(3) (4)

9,772 1,853,377-——

9,157 - 341120 3,087

495I

1,849,949

terms under the Seventh Revision title Otherdiseases of kidney and ureter (ICD No. 603) tothe Eighth Revision title Other pyelonephritis,pyelitis, and pyelocystitis (ICDA hTo. 590.1).Among these transferred terms were necrosis,kidney, and renal papillitis.

Applying the comparability ratio between “the Seventh and Eighth Revisions of 1.0288 tothe 1967 death rate for Infections of kidney(4.6 deaths per 100,000 population) gives anadjusted rate for 1967 of 4.7—about’ the samerate as that for 1968 (table 1).

The puzzling relationship between the trends

for mortality from Nephritis and nephrosis andInfections of kidney may be made clearer withthe availability of multiple-cause trends for thesetwo groups of causes. Multiple-cause data fromthe study of deaths in 1955 (the most recent

.

year for which such data have been published)show that only about 32 percent of the deathsfor which the certificates have an entry of Infec-tions of kidney are assigned to this cause.g Thesame study shows that about 52 percent of thedeaths for which the certificates have ap entryof hTephritis and nephrosis are assigned to thiscause.

15. PEPTIC ULCER

A reduction in the assignments of deaths tothe Eighth Revision title Peptic ulcer (ICDANos. 531-533) from the number that had beenassigned to the comparable Seventh Revisiontitle Ulcer c)f stomach and duodenum (ICD Nos.540, 541 ) resulted in a comparability ratio of0.9856 (appcndis 1).

The m~i,jor shift in this reduction (based onthe study of deaths occurring in 1966) MM thetransfer of an estimated 498 deaths from thosemsi:gnccl by tl~c Scwcnth Revision to Ulcer orstomach (lCl) LX(). 540) to Lllc I{ig]lth I<c.Yision

tiLlc’ (;aslr{)jcjllnaltr:tllsfcr ()[” 111(.’SC

58

Uk’t’1”(lCI)A N(). 534). ‘1’11(’.}{)~ (1’.:1111s11’sllltc(l rl-om :1

.

change in assignment of gwtrointestinal hemorr-hage wf~cn the site of the ulcer was notspecified. By the Seventh Revisio~ certificateswith such entries ycre m.sigped to Ulcer of

.

stomach (ICQ No. 540). Ancxhcr estimated 51deaths that wet-c assigmxl by the Seventh Revj-sion to Ulcer c>f duodenum (ICI? No. 541) wereassignctl to Gastrojcjumd ulcer (ICIXl No. 534).These changes arc reflcctccl in the great increasein the numlmr of deaths (or 1968 assi~ncd toG;~str(}jcj\mal ulcer (lC1)A .A’(). 534) (721dcutl)s) [)lcr tllc nllmhcr of (Icalhs (196) in 1967assi:gnc(l I(J the same Scvcnlh Rcvisio]] t.itlc(;:lstrt)ic+i~lll~tl ulcer (I(X) No. 542).

.


Estimated number ofNumbar of deaths in column (2)

Estimeted number of

Cause of death and cetagory number deaths thet went to Pepticdeaths in column (2)

that went toin 1886 ulcer (ICDA Nos.

531-533)other causes

(1) (2) (3) (4)

All cSUS13S. .. ... . .. .... .. .. .. . ... ... .. .. .. .. . .. . .. ... . ... 001 -E988

Ulcar of stomach and duodenum ... ...540.541.. ......54O.54lUlcer of stomach ........................................... ...... .540Ulcer of duodanum ..............................................541

Other auses ............... ...... .............................. Residual

I 1,863,149 I 10,172 I 1,852,977—. —

10,321

I9,429 892

5,599 4,886 7034,722 4,533 189

1,852,828 743 1,852,085

The Eighth Revision group title Peptic ulcer(ICDA Nos. 531-533) has the following threesubtitles (shown with the number of deathsassigned to them for 1969):

.—

Number ofSubtitle and category number deaths in

1969.—

Ulcer of stomach ...... ......... ....... 531 3,719Ulcer of duodenum ...................532 4,381Peptic ulcer, site unspecified .. ...533 1,212

It should be noted that the number ofdeaths coded by the Eighth Revision to Ulcer ofstm’nach (ICDA No. 531) is greatly recluccclfrom the number assigned to this same title (ICD

●

.

No. 540) by the Seventh Revision. The st~dybased on deaths occurring in 1966 shows thatthe comparability ratio for Ulcer of stomach(ICDA No. 531) is 0.6515.

The major component of the 2,084 deathsassigned to Ulcer of stomach (ICD No. 540) bythe Seventh Revision but not reassigned to thistitle by the Eighth Revision was 1,293 deathsthat were assigned by the Eighth Revision to thenew title Peptic ulcer, site unspecified (ICDANo. 533). By the Seventh Revision, when ulcer(ruptured) with site unspecified was reportedwith indication that the ulcer was internal, suchas resulting peritonitis, the ulcer was considered“peptic,” with assignment to L’leer of stomach(ICD No. 540).

As mentioned above, about 498 of the 2,084transferred deaths were assigned by the EighthRevision to Gastrojejunal ulcer (ICDA No. 534).

—— —.. - ,-, . . .

seventh Ravisioni

Eighth Revision

Cause of death and category numbar

(1)


deathsdeaths in column (2) deaths in column (2)that went to Ulcer of

in 1886 that went tostomach (ICDA No. 531)

(2)other causes

(3) (4}

All causes........................................ ....... 001 -E998 1,863,149 3,648 1,859,501

Ulcer of stomach ................. .... ............. ............ ......540 5,599 3,515 2,084Other causas... .............................. .................. Residual 1,857,550 133 1,857,477

59

REFERENCES

‘U.S. Bureau of the Census: Comparison of cause-of-death assignments by the 1929 and 1938 Revisions ofthe International Lists, deaths in the United States,1940, by H. L. Dunn and W. Shackley. Vital Statistics-Special Reports, Vol. 19, No. 14. Washington, D.C.,June 1944.

2Nation~ Center for Health Statistics: Comparabilityratios based on mortality statistics for the Fifth andSixth Revisions: United States, 1950, by M. M. Faustand A. B. DoIman. Vital Statistics—Special Reports, Vol.51, No. 3. Public Health Service. Washington, D.C., Feb.1964.

3National Center for Health Statistics: Comparabilityof mortality statistics for the Fifth and Sixth Revisions:United States, 1950, by M. M. Faust and A. B. Dolman.Vital Statistics–Special Reports, Vol. 51, No. 2. PublicHealth Service. Washington, D.C., Dec. 1963.

4National Center for Health Statistics: Comparability

of mortality statistics for the Sixth and Seventh Revi-sions: United States, 1958, by M. M. Faust and A. B.Dolman. Vital Statistics-Special Reports, Vol. 51, No.4. Public Health Service. Washington, D.C., Mar. 1965.

5World Health Organization: Manual of the Interna-tional Statistical Classification of Diseases, Injuries, andCauses of Death, Based on the Recommendations of theSeventh Revision Conference, 1955. Geneva. WorldHealth Organization, 1957. “Medical certification andrules for classification” used with the Seventh Revisionare shown on pp. 357-371.

6World Health Organization: Manual of the Interrza-~ional Statistical Classification of Diseases, Injuries, ancl

Causes of Death, Based on the Recommendations of theEighth Revision Conference, 1965. Geneva. WorldHealth Organization, 1967. “Medical certification andrules for classification” used with the Eighth Revisionare shown on pp. 415-436.

7National Center for Health Statistics: 1973 instruc-tion manual for underlying cause of death, NosologyGuidelines. Rockville, Md. Public Health Service, Nov.-Dec. 1972.

8Wrong, O. M.: Glomerular disease, in P. B. Beesonand W. McDermott, eds., Textbook of Med{cine (Cecil-Loeb), Vol. 11. Philadelphia. W. B. Saunders Company,1971. pp. 1177-1198.

9National Center for Health Statistics: Vital Statisticsof the United States, 1955, Supplement: Mortality Data,Multiple Causes of Death. Public Health Service. Wash-ington. U.S. Government Printing Office, 1965.

10Waters, W. E.: Trends in mortality from nephritisand infections of the kidney in England and Wales. TheLancet. Feb. 3, 1968. pp. 241-243.

11Hansen, M. H., Hurwitz, W. N., and Madow, W. G.:Sample Survey Methods and Theory, Vol. 1, 2d printing.New York. John Wiley and Sons, Inc., 1957. ch. 4, p.122.

1‘Cramer, H.: Mathematical Methods of Statistics.Princeton. Princeton University Press, 1971. table 2, p.558.

13 Percy, C., Garfinkel, L., Krueger, D. E., andDolman, A. B.: Apparent changes in cancer mortality,1968. Public Health Rep. 89(5), Sept.-Ott. 1974.

60

LIST OF DETAILED TABLES

Page

Table 1. Death rates for 48 selected causes: United States, 1966-69-------------------- 62

2. Deaths for 48 selected causes: United States, 1966-69------------------------- 63

3. Death rates for Chronic ischemic heart disease and for four special four-digitcategories of th,isdisease, by age, color, and sex: United States, 1968-71---- 64

.

●

.

61

Table 1. Death rates for 48 selected causes: United States, 1966-69

[Ramspm 100,000population.NumbersafterC.USCSofdc.Nharccategorynumbersofd,.fii#t6Rc.!iio,:Imtcm.tionaiClursificdfionofDisc-s,Aduplcdfor Use in the United .$tatcs,

adomcd i. 1965. Rmc$ for 1968 and 1969 arc baxd on dcatbs assiwcd m dIcsc EiBhd! Rcvi~iun camg.ry numbers: rams km 1966 and 1967 are based on deatlu msigncd w thecawgorynunkr$ of III. Seventh Revision, adopccd in 1955. TIIese caccgory numbc:s arc shown i“ III. last column of this cable.]

—— ————— — . ———. .-____==

Cause of death end category numbers of Eighth Revision

All causes -------------------------------------------

Enteritis and other diarrheal diseases--------------OO8,009Tuberculosis, all forms-----------------------------OlO-Ol9Syphilis and its sequelae---------------------------090-097Other infective and parasitic diseases-Ramsinder of 000-136

Malignant neoplasms, including meoplasms of lympbat icand hemntopoietic tissues --------------------------l4O-2O9Malignant neoplasms of buccal cavity and pharynx--l4O-149Malignant neoplasms of digestive organs andperit0nem---.-----------------------------------l5O-l59

Malignant neoplasms of respiratory system---------16O-l63Malignant neoplasms of breast-------------------------l74Malignant neoplasms of genital organs-------------loO-l87Malignant ncoplasms of urinary organs-------------l88,189M~;I~t neoplasms of all other and unspecified

-----------------------------------l7o-l73,l9o-l99Leukmia-----------------------------------------~2O4-2O7O~~u~oplasms of lymphatic and hematopofetic

---. ------------------------------2OO-2O3,2O8,2O9

Benign neoplaems and neoplasrosof unspecifiednature---------------------------------------------2lO-239

Diabetes mellitus---------------------------------------25OAnemias---------------------------------------------28O-285Meningitis----------------------------------------------32O

Major cardiovascular diseases-----------------------39O-448Diseases of heart-----------------390-398,402,404,410-429

Active rheumatic fever and chronic rheumaticheart disease----------------------------------39O-398

Hypertensive heart disease with or without renaldisease---.----.--------------...-.-..-------.&O2.&O&Ischemic heart disease--------------------------4lO-4l3

>..

Chronic disease of endocardium and other myocardl.alinsufficiency----------------------------------424,428

AI1 other forms of heart disease----4423,4254427,429429Hypertension----------------------------------4OO,4Ol,4O3Cerebrovascular diseases--------------------------43O-438Arteriosclerosis-------------------------------------44OOther diseases of arteries, arterioles, andcapillaries--------------------------------------441-448

Acute bronchitis and bronchiolitis----------------------466Influenza and pneumonia---------------------47O-474,48O-486

Influenza-----------------------------------------47O-474. ~emonia-----------------------------------------48O486

Bronchitis, emphysema, and asthroa-------------------49O-493Chronic snd unquslifI.edbronchitis----------------490,491Emphyscma------------------------.--------------------492Asthma------------------------------------------------&93

Peptic ulcer----------------------------------------53l-533Hernfa and intestinalobstmction---------------55O-553,56OCirrhosis of liver--------------------------------------57JCholelithiasis,cholecystitisand cholangitis-------574,575Nephritis and nephrosis-----------------------------580-584

Infections of kidney------------------------------------59OHyperplasia of prostate---------------------------------6OOCongenital anOmalies--------------------------------74O-759Certain causes of mortality h. earlyinfancy-------.----------------76O-769.2,769.4-772,774-778

Symptoms and ill-defined conditions-----------------78O-796All other diseases---------------------------------Residual

Accidents-----------------------------------------E8OO-E949Motor vehicle accidents-------------------------E8lO-E823All other accidents-------------------E800-E807,E825-E949

Suicide-------------------------------------------E95O-E959Hmicide------------------------------------------E96O-E978All other external causes-------------------------E98O-E999

————.. ... .-

——

1969

951.9——

L 3

i::4.0

160.03.7

46.532.714.420.37.4

18.77.2

9.0

1$:

0:9

501.7366.1

7.6

33:: ;

J::

10;: :16.4

12.4

3%$

3:::

q.:

11:41.2

4.6

1:::

::}

;.?

8;4

21.413.050.9

52.627.630.011.1

;;;

. ..

.—

1968

965,7——

i:;

::;

15;.:

46.831.814.620.57,4

18.67.2

8.9

1;:2

($;

~;:.:.

8.2

33%:

1$ j

105:816.8

12.4

3:::

3::z

16.6

1% i1.3

4.7

1;:~

4:7

4.7

$:

21.911.851.1

57,527.5;g.;

7:32.2

.—..-—

1967

935.7

3.83.51.23.5

157.23.4

48.229.414.320.47.4

18.67.2

8.3

1?:;1.71.0

506.5364.5

7.2

25.3289.7

26.615.8

102::19.0

15.1

2!::

2:::

15.3

1:::2.1

5.0

Ii::

::;

4.6

k:

24.412.234.4

57.226.730.410.86.8---

——

1966

951.3

u1.13.8

152.;.

48.528.014.120.67.2

17.97.2

8.1

1%31.81.2

:;!.;.

7.7

27.7292.7

27.415.8

1:$ ;.

14,6

3:::

3;:;

15.2

1%!2.2

5.3

J:;2.35.9

4.8

k!

:$$

34; 7

;;. :

30:910.9

5.9---

..-— ——

Category numbersaccording to theSixth and Seventh

Reviaiona

. . .

543,571,572001-019020-029001-138 ,Remainder of

140-205140-148

250-156A, 157-159160-164170171-179180,181

1568,165,3.90-199204

200-203,205

210-239260290-293340

330-334,400-468400-402,410-443

400-402,410-416

440,441,442,443420

421,422430-434444-447330-334450

451468

500480-493480-483490-493

501,502,527.1,241501,502yl.1

540,541560,561,570581584,585590-594

600610750-759

760-776780-795Residual

E8U0-E962E81O-E835E800-E802,E840-E962I1963,E970-E979E964,E980-E985Residual

.

*

.

62

Table 2. Deaths for 48 selected causes: United States, 1966.69

.

.

.

[Numbers afi.rm.~s ofduthxc -t~~n.mbcrsofthe E~htJzR.tio.l.tmtioml Cktific.tionofDkeaer, A&ptcdfm Urei. fh. L~.irtiSt.:ti, adopted in1965. kthsfwl968 and1969 arcthosc assigned tothcsc Eighth Rdoncatcgory numbers; duthsfor 1966and 1967xcthox =@edtochc=tc@ry numb= of the*wnrh Revision, adoptedti 1955.Thesecategorywmbms am show” i“ chc last column of thistable.]

Cause of death and category numbers of Eighth Revision

All causes-------------------------------------------

Enteritis and other diarrheal diseases.-.-...---..-.008,OO(Tuberculosis, a 11 foms-----------------------------olo-olfSyphilis and its sequelae.----.-.-.-...-..---...-...ogo.og,Other infective and parasitic diseases-Remainder of 000.13(

Malignant neoplasms, including neoplasms of lymphaticand hematopoietic tissues-.-...._... -...---.--._ -l4O-2O!Malignant neoplasm of buccal cavity and pharynx--l4O.l4!y::&:~Pl asms of digestive organs and

---------------------------------------150-15!hlfgnant neoplasm. of respiratory systm-...-...-16 O-l6:L4alignsntneoplasms of breast-.--.----....--..--.-.---l7fMalignant neoplasm of genital organs-.--------..-l8O.l8:-li~ant neoplasms of urinary organs.-.----------l88,18!Mal@nant neoplasms of al1 other and unspeciffedsites------------------------------------l70-l73,l9o-l9f

~uk~ia------------------------------------.-----2o4-2O;Other neoplasms of lymphatic and hematopoietictissues-.--.-.-.....--.-.--.-..---.-..-..2oo-2o3.2o8 20$,

Benign neoplasms and neoplasms of unspecifiedna~re'..---.-......-..---...-.-.-.......--.----....2lO.23~Diabetes melli~s---------------------------------------25ch~i~S-------.----------- . . . . . ..--... -.-----. -.----28 o.28~Meningitis-..-.....-....-.-.---..-------.--------.----.-32C

Major cardiovascular diseases.---..----.-.--..-----.39O-&8DiSe8ses of heart-..-..--..-..-.-.39O-3g8,4O2,4~,4lO-42gAct ive rheumatic fever and chronic rh-ticheart diseaee----------------------------------ago-wa

Hypertensive heart disease with or without renaldisease----------------------------------------&o2,&~

Isch=ic heart disease--------------------------4lo-4l3Chronic disease of endocardium and other myocardial

insufficiency-.-..-.--.-----..--.----------.--42&,428All other forms of heart di6ease--.-4423,4254427,429429

Hypertension--..-.--....--------...--------.-~ OO.4Ol.bO3CerebrOvascular d~seases--------------------------43o-438Arteri0sCler0sis--------------------------------------woOther diseases of arteries, arterioles, andcapillaries-.-.-...---.......--...-.-.-...-.--...44l-~8

Acute bronchitis and bronchiolitis----------------------4662nf1uenra and pneumcmia.-.-..-.....-..486 -~7O.474.48~.486

Influ~=-----------------------------------------47o-474~e~0n~a-----------------------------------------48O-486

Bronchitis, emphysema, and asth~-------------------&9o-493Chronic and unqualified bronchitis-.-..-..-_.__49f),&9l=phys~---------------------------------------------492Asthma------------------------------------------------493

Pwic ulcer----------------------------------------53l-533He~ia and intestinal Obst~ctiOn---------------55O-553, 560CirrhOsis Of liver--------------------------------------571Cholelithiasis, cholecystitis and cholangitis--.--..574,575Nephritis and nephrosis---..-......-.....---......--58& 584

Infections of kidney------------------------------------590Liyperpla5i.9of prOstate.....-..-....---....._ ....-_ -.-6ooCongenital ancmmlies..-.-......-....-----._.._.. -.74O.759Certain causes of mortality in early

in fancy ------------------------ 760-769.2,769.4-772,774-778Symptoms and ill-defined conditions--..-...-----..-.78O-796All Other diseases---------------------------------Residual

Accid~ts-----------------------------------------E8OO-E%9MOtOr vehicle accid~ts-------------------------E8lO-E823All Other accidents-------------------E8OO-E8O7,E825-E949

Suicide-------------------------------------------E95O-E959H~tCide-.-..- . . . ..---. -..-.. ---. ------. ---------. E96o.~978All Other =te~al Cau=s-------------------------E98o-E999

1969

,921,99(

2,61:5,56:

54:8,06!

323,09;7,55:

93,98(66,03f29,08:41,00E14,89>

37,82514,45C

18,252

4,67738,5413,3181,719

,013,015739,265

15,432

16,286669,829

7,47530,2438,426

207,17933,063

25,082

1,28668,3655,971

62J94

3;,:::

2;:3?;,

9,3127,500

2~,;3;

9:417

8,7502,49917,008

43,17126,160102,724

l;:,;M;

60;59422,3641;,:;;

,

1968

1,930,08:

2,94(6,29i

Sst7,95f

318,54j7,294

93,56:63,48:29,08140,93614,792

37,24714,375

17,774

4,94838,3523,4941,707

1>023,399744,658

16,358

17,698674,747

7,83628,0199,063

2;;,;:;>

24,720

1,4327;,:;:

66:430

33,0786,205

24,1852,688

9,4607,758

29,183:,;;;,

9*3952,64716,793

;;,:::

102:192

114,86454,86260,00221,37214,6864,315

1967

1,851,32

7,506,902,386,96

310,98.6,71(

95,32(58,08(28,21’40,40114,65(

36,76:14,33(

16,48:

5,01:35,04:3,46[2,04(

1,002,111721,26E

14,17t

49,975573,153

52,69731,26711,151

202,18437,564

29,944

9S856,8921,475

55,417

30,3185,306

20,8754,L37

9,8259,814

27,8164,38310,941

9;0063,13617,328

48,31424,09868,163

l;;,;;~

60;24521,32513,425

---

1966

L,863,14

7,557,622,19:7,691

303,73{6,80(

95,07!54,93i27,53:40,37[14,16(

35,0%14,0K

15,8LX

4,92:34,5973,6522,324

.,010,812727,002

15,012

54,176573,191

53,58131,04211,380

204,84138,907

28,682

98763,6152,83060,785

2;,;::

20:2524,324

10,32110,0782:,::;

11;540

9,4983,21718,158

51,64423,96067,947

113,56353,04160,52221,28111,606

..-

(% tegory numbersaccordin

sto the

Sixth an SeventhRevisions

. . .

543,571,572001-019020-029001-138,Remainder of

140-205140-148

150-156A,157-159160-164170171-179180,181

1562 L165,190.199204

200-203,205

210-239260290-293340

330-334,400-468400-402,410-443

400-402,410-416

440,441,442,443420

421,422430-434$4J442

450-

45L-468

500480-493480-483490-493

501,502,527.1,241501,502527.1241

540,541%~,561,570

584,585590-594

600610750-759

760-776780-795Residual

E800-E962E81O-E835E800-E802,E840-E962E963,E970-E979E964,E980-E985Residual

63

Table 3. Death rates for Chronic ischemic heart disease and for four special four-digit categories of this disease, by age, color,and sex: United States, 1968-71

=

12

i

i78

9

.:?12

13141516

1718

H

21

ii24

25

H28

293037.32

33343536

3738

::

41424344

45464748

49505152

EighthLevisio:

}12

112.12

12.22

[Rat., p., 100,000po—.

Cause of death, color, sex, and year

Chronic ischemic heart disease

Total:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

White male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

Whit;lfemale:--------------------------------------------

19m--------------------------------------------1969--------------------------------------------1968--------------------------------------------

Al;9;;her male:--------------------------------------------

1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

Al+9;;her female:--------------------------------------------

1970--------------------------------------------1969---------------------J----------------------1968--------------------------------------------

Chronic fschemic heart disease with or withoutCardiOvascular isease with hypertensive disease

Total:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

White male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

White female:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

All other male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

411 other female:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

Cardimascular disease without mention of chronicIschemtc heart disease with YPertensive disease

Total:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

white male::;;; --------------------------------------------

---------------------------- ----------------1969--------------------------------------------1968--------------------------------------------

!?h~;lf~m~le:----------------------------------------

1970:-:-----------------------------------------1969--------------------------------------------1968--------------------------------------------

tion ins——

rOtall

151.5150.1150.2150.2

158.7158.4158.0157.7

152.0148.6149.0148.1

134.7136.6137.6140.3

116.0117.9118.4123.8

9.69.7

1{::

8.48.58.59.0

10.910.911.111.2

8.78.89.710.0

1:::10,311.3

11.011.411.612.4

HI8.28.5

10.310.610.711.5

——..

UnderL yea]

0.1

:::0.4

0.10.10.30.3

0.;0.40.3

0.4

0.;

0.70.4

1.;

0.6

o.i

.

0.1

0.1

1-4,ears

0.00.00.00.1

0.10.10.00.0

0.;0.0

0.30.1

o.i

0.;

0.6

-

o.i

.

5-9rears

——-

0.10.00.00.0

0.00.0

0.;

0.10.0

0.;

0.2

o.i0.1

0.1

o.i0.1

0.00.00.00.0

O.i

0.0

0.;

-

o.i

0.1-

0.00.0

0.00.0

LO-14{ears

.—

:::0.00.0

0.1

%:0.0

!::0.00.0

o.i

0.10.1

0.6

--

0.6

.-

-

0.0

0.6

0.0

0.;

.—

L5-19years

—.

0.2

::10.0

0.20.10.10.0

0.10.00.1

0.20.10.20.2

0.4

::~0.1

0.0

0.;

0.0

0.0

0.;

0.1

-

0.00.00.00.0

0.0

0.6

0.0

0.;

20-24years

—-

0.30.20.30.2

:::0.30.2

%:0.10.1

::;1.61.3

%20.30.2

0.0

:::0.0

0.00.00.0

-

0.0

0.1

o.i

0,10,0

::i

0.10.00.10.0

0.00.00.00.0

!5-29rears

0.8

:::0.7

0.9

;:;0.7

M0.30.2

:::

::;

1.61.52.81.7

0.00.0

:::

0.00.00.1

0.60.0

0.10.1

0.:

0.20.1

0.20.20.30.2

0.10.10,20.0

0.10.00.10.1

30-34years

2.82,8

::;

3,12.82.92.7

M0.80.7

11.611.014.110.9

4.96.86.59.9

0.10.10.10.1

0.10.00.10.1

0.10.00.00.0

0.70.10.51.2

:::0.1

0.50.70.80.8

0.10.30.30.3

0.20.30.20.2

.

See footnotesat end of table.

64

Table 3. Death rates for Chronic ischemic heart disease and for four special four-digit categories of this disease, by age, color,and sex: United States, 1968-71-Con.

[&ws p+r 100,000 pap.lacion in +xcified groupsl

35.39years

8.48.6S.47.6

1::;10.09.3

2.6

;::2.1

33.332.534.628.9

16.619.916.616.6

0.40.40.40.4

0.40.40,20.2

::10.20.1

2,62.2

;:;

k;1.11.7

::;

i:;

0.80.60.70.7

0.40.60.50.5

40-44years

20.419.519.319.3

26.424.824.523.9

6.35.85.95.8

65.671.970.072.8

41.538.841.343,9

0.90.8

M

:::1.01.1

0.30.40.30.3

4.5

::25.3

2.32.92.82.6

H

;::

1.6

1:;1.7

0.81.1

;:;

45-49years

40.341.238.739.0

55.255.752.250.8

13.713.412.113.3

124.2133.6133.3133.3

69.376.072.382.2

R

i:?

2.42.52.12.1

0.50.80.90.8

7.07.46.59.1

4.1

:::6.6

5.8

;:;

3.4

::!4.5

2.6

M2.9

-—.—

50-54years

—.—

76.076.375.876.2

103.9103.5102.8103.0

29.530.529.528.6

216.4210.7229.6224.8

131.4138.2130.8147.6

::;

2:;

4.64.54.45.5

2.22.12.12.2

13.912.018.312.8

10.214.5

1%:

10.510.810.711.8

i::

R

4.64.54.65.0

——.——

55-59years

136.7138.1137.9140.6

189.6189.9187.5186.4

60.960.761.262.6

353.9347.3365.3388.4

205.8226.1231.1260.5

;.:

;:;

10.59.6

J::

4.54.94.85.0

24.924.625.126.5

16.619.721.225.5

16.417.918.4L9.7

12.913.214.514.2

;:;

10:2

60-64years

238.(242.[249.!255.(

325.(328.(336.Z339.~

125.;126.1126.(130.:

515.;541.;588.1606.1

31v3.1374.;432.C460.2

15.s16.416.518.6

18.219.219.121.5

10.310.710.210.3

35.332.140.449.9

31.934.536.750.1

25.827.329.830.5

22.023.424.824.9

l&.415.516.216.7

65-69years

406.2424.C437.2447.:

539.6557.2552.i558.2

252.I265.1271.6280.5

755.s808.6942.6982.9

562.C594.c775.1834.0

28.530.131.936.1

32.133.533.036.4

20.922.823.228.5

54.055.776.584.0

51.950.780.178.1

39.642.444.049.5

33.835.935.838.5

26.527.528.232.5

.—

70-74years

746.1753.7800.2819.1

937.1943.2988.7

1,012.4

550.0560.5590.5606.2

1,231.51,253.31,581.51,630.6

987.5959.1

1,152.21,112.6

53.656.261.361.8

55.856.863.263.7

;$~

53:653.2

k;115.3111.9

90.292.4105.5117.0

62.162.3;:.:

51.452.256.861.5

48.849.651.859.0

75-79years

1,362.31,383.21,348.11,377.4

1,643.01,659.71,618.81,630.9

1,155.31,175.51,155.41,193.7

1,685.31,745.91,649.21,599.2

1,356.31,364.71,217.21,279.4

97.596.397.3103.2

97.196.189.9100.7

93.992.898.2102.9

121.7119.5128.9111.0

129.3126.9127.0122.9

92.1;:.;

102:4

77.280.377.881.9

85.488.088.197.6

——

80-84years “

2,440.;2,480.A2,457.;2,470.(

2,846.(2,867.12,760.:2,752.;

2,268.!2,302.:2,339.I2,367.;

2,163.(2,112.:1,975.[1,925.;

1,721J1,929.;1,787.11,806.:

158.2161.7166.1167.8

147.3154.6151.0151.7

168.7168.1179.4182.1

102.7138.5131.6140.5

143.7151.4146.9142.1

132.6141.4138.2144.9

109.9105.1105.1107.6

132.6144.7145.5154.4

85 yearsand over

5,203.44,800.4;,;;;.;>.

5,675.35,090.25,640.15,620.5

5,228.44,925.3:,:::.;,.

3,324.52,872.52,465.62,785.5

3,228.92,951.72,741.32,980.6

271,7261.0295.1293.1

234.o217.5239.2249.0

300.7295.3354.8339.5

159.2167.8L32.8145.5

228.9208.5182.5215.3 I

204.1 ~198.2232.4246.1

=

;:

::

.:

.1

.2

.3

.4

.5

.6

.7

.8

.9:0

143.7 45139.6 46151.7 47160.4 48

218.9 49214.5 50269.5 51280.6 52

Table 3. Death rates for Chrontc kchemic heart disease and for four spec id four -digit categories of this disease, by age, color,and sex: United States, 1968-71-Con.

—

[Racespm 100.000 popI——. .—. —

EighthRevisionumber

12.22

12.32

12.42

Cause of death, color, Bex, and year

Cardiovasculardisease without mention of chronicIschemic heart isease ~ith YPertensive

disease—Con.

kll other male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

).11other female:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

Chronic ischemic heart disease with or withoutcardiovasculardisease without mention of

hypertensive disease

l’otal:

1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

ihite male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------l968-----------------------,---------------------

Jhite female:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

kll other male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

ill1 other female:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

Cardiovasculardiseas~ without mention of chronicischemic heart disease wfthout mention

of hypertensive disease

rotal:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

White male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

tiite female:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

A1l other male:1971--------------------------------------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

tillother female:1971---------------------------:----------------1970--------------------------------------------1969--------------------------------------------1968--------------------------------------------

i..i.spccificd~c..psj

?Otal1

22.924.626.027.9

25.427.228.330.4

107.4106.7106.9106.5

119.4119.8119.4118.8

106.9104.6105.1103.9

77.279.380.081.4

59.260.261.663.7

23.522.321.821.2

23.222.222.021.3

23.822,522.121.5

25.924.021.921.0

21.620.318.218.4

rideryear

.—. .

0.7

0.00.10.20.3

0.i

:::

0.i

:::

0.4

0.i

0.;

1.6

% i

o.i

o.i0.1

0.i

1-4tears

0.00.00.00.0

0.00.00.00.0

o.;

0.3

0.i

0.;

0.00.00.00.0

0.00.00.0

0.i0.0

5-9ears

-—.

0.0

% :0.0

0.0

0.6

0.00.0

0.6

0.2

0.i

0.1

0.i

0.00.0

0.i

0.6

0.0

0.i

.0-14rears

0.1

:::0.00.0

0.10.00.00.0

0.00.00.00.0

0.i

o.i

0.0

0.0

0.0

15-19rears

o. i

:: i

0.1

0. i

0.10.10.10.0

0.10.00.10.0

0.00.00.1

0.10.10.10.1

0.3:.;

0:1

0.00.0

0.Ii

0.6

0.0

0.1

0.i

o.i

ZO-24rears

8::0.90.3

0.1

0.i0.1

0.20.20.10.1

0.2

:::0.2

0.10.1

M

0.80.50.70.6

0.10.4

0,i

0.00.00.00.0

0.00.00.00.0

0.0

O.li

0.10.1

o.;

0.10.20.1

25-29years

Ht;0.70.61.61.4

:::0.50.4

0.70.90.70.6

0.20.30.10.1

1.4

$::2.1

::;

::;

0.1

% i0.1

0.10.10.00.1

0.00.0

k:

0.10.30.3

o.i0.1

IO-34rears

4.24.26.54.1

:::4.35.8

2.0

t:1.6

2.6

i:;2.1

0.80.60.50.5

5.7

;:;4.5

2.22.4

$ z

0.30.20.30.2

0.30.20.30.2

0.10.10.10.0

1.0L. O1.61.2

:: ‘i’0.40.4

.

.

1Figures for age not stated are included in total but not distributed among age groups.2In anticipationof a possible change in the classificationof these terms and for the benefit of those inteksted in doing

further study, NCHS has created these special four-digit subcategoriesunder category 412 that are used instead of those listed inthe Eighth Revision ICOA. These special four-digit subcategories permit the separation of deaths due to cardiovasculardiseasewithout evidence of a disease of the coronary arteries from those d“e to other conditions classifiable to chronic ischemic heartdisease with or without mention of cardiovascular disease. Subcategories 412.1 and 412.2 together are equivalent to ICOA category412.0, and subcategories 412.3 and 412.4 together are equivalent to lCOA category 412.9.

10.7

1;:$11.0

1!::9.59.3

5.55.8

:::

7.88.3;.:

1.71.5

i:i

17.618.817.913.1

:::

:::

0.80.80.80.8

::?0.91.2

.

:::0.20.1

2.42.93.22.5

1.51.31.71.1

.—

40-44yearn

17.622.724.224.4

%;21.523.1

14.013.212.512.2

21.319.719.118.4

4.33.i’

::2

33.838.335.035.6

15.616.014.013.4

;:?

;::

2.52.7

i:;

0.90.60.70.7

9.7

::;7.6

4.83.3

::;

45-49years

32.142.440.539.8

26.933.235.337.1

27.127.524.925.2

42.562.939.137.7

8.58.5

:::

64.767.769.970.6

27.929.225.431.5

:::

2::

6.96.4

::2

:.:

1:61.5

:$.$

16:313.8

10.57.2

:::

[Rates per 100,000 population i. $pecified groups]

,

&ble 3. Death rates for Chronic ischemtc heart disease and for four swcial four-digit categories at this disease, by age, color,and sex: United States, 1968-71-Con.

:! ,539

F

ears

i

79.782.495.799.5

67.987..979.486.8

92.092.893.293.7

139.6142.9140.1138.7

39.438.639.439.5

188.1178.9196.3209.3

92.691.9104.2112.7

19.718.817.617.8

26.724.223.223.0

8.5

;:;

61.261.348.253.0

28.732.626.335.5

60-64years

103.3110.1127.0138.8

96.0101.3132.0128.1

162.2165,9170.7174.6

240.3.244.5250.2254.8

83.782.784.286.3

280.5308.9331.4327.4

155.8176.5199.7215.4

34.832.732.431.4

44.640.942.138.2

17.217.216.116.9

96.790.689.290.1

6fJ.462.563.566.6

——

T50-54 55-59years years

——

65-69years

138.9147.1164.3198.1

127.7140.6190.4218.4

279.8294.6303.1305.7

400.7420.4414.6415.5

170.5178.5184.6185.1

417.7:;;.:

555:3

278.2296.7379.1423.6

58.457.658.156.2

73.167.468.867.8

34.236.435.634.7

145.3L48.O154.4145.5

104.3106.0125.6113.9

——

70-74years

180.6181.3254.8283.8

197.1193.5245.8242.2

518.7529.0561.3574.9

697.0707.6738.6756.5

376.3385.1403.3414.2

713.0743.3938.9974.4

504.9500.6631.3594.2

111.7106.2110.1108.8

132.9126.5130.1130.7

78.475.787..779.7

253.2240.1272.6260.6

194.7172.6169.7159.2

75-79years

186.0219.5227.3231.5

235.9247.4217.8241.8

965.6984.0958.3977.7

1,229.7.1,249.81,219.61,224.0

802.7817.0800.7825.1

1,042.61,069.61,007.01,006.3

724.6734.8658.0702.4

207.2207.0197.9194.1

239.5233.6231.522/$.3

173.3177.6168.4168.1

334.9337.3285.9250.4

266.5255.6214.42J.2.4

.——

—.—.

80-84years

224.7255.6244.7221.6

249.5319.7242.9283.2

1,759.71,783.41,782.41,783.8

2,156.12,155.02,095.62,089.9

1,602.71,628.91,662.01,669.0

1,358.91,333.91,244.71,225.7

993.21,097.71,100.01,071.6

390.2~;.;

374:1

433.3453.1408.4403.4

364.4360.4352.5361.8

w:. ;

353:9337.8

335.0361.0298.0309.5

——. ——. —

85 yearsand over

263.3245.4237.7280.0

359.2341.9327.5381.9

3,840.43,554.74,123.44,114.6

4,371.43,914.34,347.34,328.0

3,618.63,614.74,469.34,407.0

2,1s1.01,912.61,629.51,865.5

1,942.11,806.31,716.31,831.9

926.2818.8901.9883.1

890.2800.7971.6941.5

751.0546.7465.6494.5

-J;;$~

515:0551.4

=

1

;4

:

i

1:1112

13

ii16

17181920

21222324

25262728

29303132

3334)5)6

)7)839iO

ili2b3)4

$5/6b?~8—

67

APPENDIX 1

COMPONENTS OF COMPARABILITY RATIOS FOR 15 LEADING CAUSESOF DEATH AND THEIR MAJOR SUBCATEGORIES

Data shown in table I are for the most partpreviously unpublished statistics from a study ofthe comparability between the Seventh andEighth Revisions of the International Classifica-

~ tion of Diseases. Provisional estimates ofselected comparability ratios and a brief sum-mary of the statistical design of the compara-bility study have been published in MonthlyVital Statistics Report, Vol. 17, No. 8, Supple-ment, October 25, 1968.

The set of comparability ratios shown belowwas computed to assess the de~ee of discontinu-ity between 1967 and 1968 for the 15 leadingcauses of death and their subcategories shown intables 1 and 2. For each of these causes and~subcategories a comparability ratio wasespecially computed for the present report bydividing the estimated number of 1966 deathsassigned to the Eighth Revision category num-bers corresponding to the title shown in thestubs of tables 1 and 2 by the number of 1966deaths assigned to the nearly comparable cate-gory numbers of the Sixth and Seventh Revi-sions shown in the last column of tables 1 and 2.

This pitrticukr set of category numbersaccording to the Sixth and Seventh Revisionswas used in the construction of these compara-bility ratios because trend data for 1950-67 wereavailable for the titles corresponding to thesecategory numbers. It turns out that, with fewexceptions (which are designated by a footnote2 in the table below), this set of category num-bers for the Sixth and Seventh Revisions is thesame as the set used to compute for these sameEighth Revision titles the above-mentionedpublished provisional comparabilityy ratios.

It will be observed that even for thoseEighth Revison titles for which the set of Sixth

and Seventh Revision categories used for thepresent report are identical with the set used forthe published provisional ratios, the provisionalratios are sometimes slightly lower than theratios shown in this report. This differenceresults from a better computational procedureused to compute the ratios for the presentreport.

The ratios shown below in column (6) oftable I were computed by dividing the estimatednumber of 1966 deaths assigned to the par-ticular cause using “*e ‘Eighth Revision, ICDA(column (2)) by the number of 1966 deathsassigned to the equivalent cause or combinationof causes using the Seventh Revision (column(5)). Adjustment for differences in revisions ismade by merely” multiplying the original figuresby the appropriate ratio.

Due to the changes in interpretations andcotig rules for chi.ssifying causes of death fromone revision to another, deaths assigned to anEighth Revision cause or group of causes rarely *had been coded to ordy one Seventh Revisioncause. That is, in most instances, some deathsnow assigned to a“ particular ICDA cause hadbeen coded according to the ICD to causes other .than the selected comparable causes. Thus, thedifference between the total estimated numberof deaths assigned to a particular Eighth Revi-sion cause or group of causes (column (2)) andthe estimated number of deaths assigned to thisparticular Eighth Revision cause that had beencoded to the selected comparable Seventh Revi-sion cause (column (3)) is simply the estimatednumber of deaths that had been previouslyassigned to Seventh Revision causes other thanthe selected comparable causes and are nowcoded to the particular Eighth Revision cause.

68

. * 1

Table 1. Componentsof canparabilityratios for 15 leadfngcauses of death and their major subcategories fOr ccmpar~g assignmentsby Eighth Revision with those by SeventhRevision,based on deaths occurring in 1966

Eighth Revision


(1)

1. Diseases ofheart------390-398,402,40442!O-42!

Active rheumatic fever and chronicrhematic heart disease-.----39O-39

:stim.atedwmber ofIeathsin1966

(2)

730,261

17>293

:stimated[umberof!eathsin01. (5)hat wentto (2)

(3)

719,550

44914,4365,6661,693773

6,304

570,220158,0124111;;:

3,~:;

2,2611,142

49,1754;,M;

28,277706

1,051

7,69318,827

53,43311,34542,088

14,724443

14,2815,6001,686759

6,236

Seventh Revision

Cause of death and categorynumber

(4)

Oiseasesof heart-'------------------------------------------------------4OO-4O2,4lO-U3

~e~atic fever----------------------------------------------------------------4oo-4o2~rOnic rhe~atic heart disease------------------------------------------------4lo-4l6Diseas@s Of mitral valve---------------------------------------------------------4loDiseases of aortic valve specified as rhematic--------..............-----.------allDiseases of pulmonaryvalve and other endocarditis,specifieda.qrhe~atic...413,414Other rhc~atic heart di$eases-------------------------------------------4l2,4l5,4l6

Arterioscleroticheart disease, includingcc.ronarydiseaseArterioscleroticheart disease so described

-------------------------420‘-----------------------------------42CI.0

Heart disease specified.ssinvolving coronary arteries----------.----..---....-42O.lAngina pectoris without mention of coronarydisease----...-.........-----------42O.2

Chronic endocarditisnot specf.ficdas rhematic ....----------------.-....--..------42lOf mitral valve, speciffedas nonrhematic---.----------.-...---.....----------421.OOf aortic valve, not specified as rheumatic------------------------------------421.1Of other valves, not specified as rhematic---------.--------............42l.2-42l.4

Other myocardid. degeneration---------------..-........-------.---------....-..-...422with arceri0scler0sis----------------------------------------------------------4zz.lHithOut mentiOn Of arteri0sCler0sis--------------------------------------4zz.o,4zz.2

Other diseases Of heart--------------------------------------------------------43o-434Acute ~d subacute end0carditis--------------------------------------------------43oAcute myocarditis and acute pericarditis,not specifiedasrheuratic'------------------------------------------------------------------43l,432

Functionaldigease of heart--..-.-.----------------..-.......-........-----------433Other and unspecifieddiseases of heart---.-.---...--..------.--.------.....--...4~

Hypertensiveheart d~sease-----------------------------------------------------44o-443Hypertensiveheart disease with artcriolarnephrosclerosis--------..---.-......--442other hypertensiveheart disease-----------------------------------------44o,4kl,@3

Rheumatic fever and chronic rheunatic heart disease--.....-....------..4OO-4O2.4l@4l6fie~atic fever--------------------------------------------------------------4Qo-4o2~rOnic rhe~atic heart disease----------------------------------------------4lo-4l6Diseases of mitral valve------... -.. -.. - . . ..-.. ------.. -----... -.- . . . . . ..-. ----4loDiseasas of eortic valve spacified as rhematic .. ..- .. . . .. ..-----. --.----- . . . ..qll

Disaasas of puhuonaryvalve and other endocarditis,specified asrhemaatic-----------------------------------------------------------------

Other rhe~atic h-cartdiseeses-----------------------------------------41z,~;~I$~$

umber ofeaths in1966

(5)

727,002

45614,5565,7181,713773

6,352

573,191158,802414,101

288

3,785166

2,3111,308

49,79641,9357,861

31,;:;

1,06510,00819,212

54,17611,60642,570

15,:4;

14,5565,7181,713

7736,352

Ratio:)1. (2) +:01. (5)

(6)

1.0045

21.1519

Sae footnotesat end of table.

I

-10

Table 1. Components of ccmparabilicyratfos for 15 leading causes of &ath and theirmajor subcategories for comparingassignmentsby Eighth Revision with tbnse-by SeventhRevision,baaed on deaths occurring in 1966-Con.

Eighth Revision


(1)

1. Diseasesof heart—con. :

Hypertensiveheart disease with orwithout renal disease--------4O2,404

Xschemicheart disease--------4lO-4l3

Chronic disease bf endocardiumandother myocardialinsufff.ciency-------.--------424,428

All other forms of heartdisease----------42O-423,425-427,429

2. Malignant neoplasms, includingneoplasm of Iyuphaticandhematopoietictissues----------140-209


:stfmatedumber ofle;;~ in

(2)

21,350

656,691

9,768

25,156

304,262

+

Wti=tedumber ofieathsin:01. (5):hatwentto (2)

(3)

20,4359,67210,763

569,715157,749411,678

1288

8,6881,469129283

1,0576,983236

23,375654892

4,34417,485

301,920

6,744143

1,6142,2052,782

—

Seventh Revision


(4)—-

Hypertensiveheart dfseese-------------------------.-....-..-........---------~O-~3Hypertensiveheart disease with arteriolarnephrosclerosi,v------.-------.-......442Other hypertensiveheart [email protected]. ~43

Arterfoscieroticheart disease, includinscoronary disease----..-........-.-....--42OArterioscleroticheart disease so described--------.-..-......-.-...--.----..-420.OHeart disease specifiedas involvingcoronaq arteries....-.------...------...42O.1An8f.IIapectoris without mention of coronary disease------------.--...-.....-..42O.2

Nonrheumtic chronic endocarditisand other myocardfal degeneration.......-...42l.4z2Chronic endocarditisnot specifiedas rhe~tic----.- ................------.----42lOf mitral valve, specified aS n0nrhe~tic----------------------------------42l.oOf aortic valve, not spscifiedas rheumatic---------.--..............-..----42101Of other valves, not specifiedas rhe~tic.- ....-...-...........-----42l.2-42l.4

Other myocardial degenerationwithout mention of arteriosclerosis-------422.0,422.2Othar myocardial degenerationwith arteriosclerosis-----.--.----.......--.....422,1

Other diseases of heart---------------~--------.---.---.---..................-43O-434Acute and subacuteendocarditis-------------------------------------------------43oAcute nyocarditisand acute pericarditis,not specifiedasrhe~tic------------------------------------------------------------------43l,432~ctiO~l disease Of heart-----------------------------------------------------433Other and unspecifieddiseases of heart---...-....-..-.-......---..-------.....434

!alignsntneoplamra, Includfngneoplasms of lyuphaticand hsmatopoietf.ctissues-----------------------------------------------------------------------l4o-2o5

Malignant UeG@aSm of buccel csvity and pha~..- ....-.-..................---l4O.148of lip--------------------------------------------------------------------------l4oOf tongue--------------------:------------------------------------------------l4lOf other and unspecifiedparts of buccal cavi~-----------------------------142.144Of phe~-----------------------.....---.-..--..-.-....--.-...........--..l45.l48

> ,

Ihmher ofleathsfn1966

(5)

54,17611,60642,570

573,191158,802414,101

288

5;,;:;

’1662,3111,3087,861

41,935

31,042757

1,06510,00819,212

303,736

6,;~~

1,6292,2242,797

Ratio:

:01. (2) +Col. (5)

(6)

0.3941

21.1457

20.1823

0.8104

,

21.0017

. * ‘

.Table 1. Components of comparability ratios for 15 leading causes of death and their cmmjor subcategories for comparing asaignmcnts by Eighth Revision with those by Seventh

Revision, baeed on deaths occurring in 1966-Con.

Eighth Revision


(1)

2. UcliSnant neoplaoms, etc. -con. :

:sti!Mtedlumber ofIeaths in

1966

(2)

:stimatedwmber ofIeaths inml; $:(t

to (2)

(3)

——

94,559

5,46117,623

65232,616

4,5681,397

1,1515,814

18,1;!1,491

10,5386,543

2,1124,4313,1f19

1: ,::f., ---

54,841

2,62320,891

30,519

80827,377

40,1757,6145,6979,1b5

85015,856

1,0131:, :3;

8;246

Seventh Revisim—- —

Cause of deeth ●nd category number

(4)

Halignant neoplasm of digestive organs ●nd peritoneum, not specified assecondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l5O.l5~. 157.159Of ●sopha us--------------. ------. -..-. ------. -----------------------------------l5O

Eof Stomcc -----------------------------------------------------------------------l5lOf macll intestine, including duodenum-------. -----------------------------------l52Of large Intestine, ●xcept rectw------------------------------------------------l53

Cecum, ●ppendix, and ●scending colon-----------------------------------------l53.OTransverse colon, including hepatic and aplenic

flexures-- . . ..---. --... --.-. -.-.. -.-----. -----------------------------------l53.lDewsending colon . . . ..-. -.---- . . ..-... -.--------------. -----------------------l53.2Si~id CO1O” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..- 153.3Mu tiple parts of large intestine--. --.--. ------. --. ----. -.- . . ..--. ----------l53.7Lcrge intestine (including colon), part unspecified--------------------------l53.8Intestinal tract, part unspec!fied---------- ..-------. -----------------------l53.9

Of rectum-----------------. -----. ---------.. -.-. - . . . ..-. ---. -.-. -.-.. -.--. --... --l54Of biliary passages and of liver (stated to be

primry sice)-.----------.. -.---. -------. -------. ------. --.---------------. -----l55Liver--------. -------------------------.-----.-------------------------------l55,OOther ●nd multiple sites of biliary passages----... -.-. ----------------155 .l,l55.8

Of liver not stated whether primary or seccndarys-------------------------------156AOf pancreas-----. ------. -------------------. --. --.-. ------------------. ----------l57of peritoneum and of unspecified digestive organs.. --------------------------l58,l59

Mclignant neoplasm of respiratory eyiitem, not specified assecondary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l6O.l64Of larynx-----------. ------------------------------------------------------------l6lOf bronchus ●nd trachea, and of lung specified m

primry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l62

3Of lun , unspecified ●s to whether primnry or

aecon ary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l63Of other parts of respiratory systm-------------. ---------------------------l6O,l64

Mclignant neoplasm of breast---------------------.--------.----------------.--.----l7O

Malignant nroplaam of genital organs-----------. ---. ------. ----. -----------. ---l7l-l79Of cervix uteri.. -.-. --.- . . . . ..-. -... ----... --... -.-. ---.. -.- . . . ..--. -.-. --------l7lOf other and unspecified partn of uterus--------.. ----------.. -.--. -.--------l72-l74Of ovary, fallopian tube, and broad Ii agent-..-..- . . . ..-. -.- . . . ..-----. --.. ---.-l75

fOf other and unspecified female genita organs-. --.-----. ----. -------------------l76Of pmamte-----..-----. ---. ------. -----.. --.. -.-. -.-. -.-----. ----------. -.------l77Of ●ll other and unspecified male genital organs- . . ..-. ------. -.-------------178 .l79

Malignant neoplasm of urimcry organs--------- . . ..--... -... -------. ---. ---------l8O.l8lOf kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l8OOf bladder ●nd other urinary organa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..lSl

‘umber ofeatha in1966

(5)

95,0795,505

17,623693

32,8114,605

L,4721,1515,814

18,1;!1,536

10,663

6,5842,1124,4723,149

16,3601.,691

54,9342,623

20,913

30,565833

27,533

40,37e7,6655,7319,16?

86:15,941

1,01214,16[

5,841S,32!

Ratio:01. (2) +Col. (5)

(6)

See footnotes ●t end of table.

Table 1. Components of comparability ratios for 15 leading causes of death and their @or subcategories for comparing assignments by Eighth Revision with those by SeventhRevision, based on deaths occurring in 1966-Con.

Eighth Revision II Seventh Revision


(1)

2. Malignant neoplasm, etc. -con. :

Malignant neoplasms of buccal cavityand pharynx-..---.-----------l4O-l4!

Malignant neoplasms of digestiveorgans and peritoneum--------l5O-l5!

:stimated,=ber of:eathsin1966

(2)

7,205

91,S48

stimatedumber ofeaths in01. [5)hat wentto (2) II


‘3) II(4)

34,6674,545

3587,1521,0081,7921,31s1,40s

17,0S6

13,92615,558

7,5483,3984,612

6,638126

1,6032,1942,715

90,664

5,46117,547

65232,41S4,4941,3971,1515,774

478

16>248l,4s5

Malignant neoplasm of other and unspecified sites. ----- . ..----. ------l56B. 165,190-199Of skin . . . . . ..-... ----- . ..-------. ---. --... -.---. -..-. -... - . . . . ..-- . . ..-. -.-l9o.l9lof eye--. --.-. ---------------------------.------------.--..-.-.-----------------l92Of brain and other parts of nervous systeIn----------------------------.--.------l93Of thyroid gland---------------------------------------..------.----------------l94Of bone----------------.---------------.--.-.-----.---.---.-.....-.-.----------.l96Of comective tissue-----------------------..-------.-.-.--.-.------------------l97Of other specified sites, not stated to be secondary-..--------------------l95,199AOf unspecified sites--------.-------------------.--.-.-.----------l56B,165,198,199B

Leukemia and aleukmia------------------------------------------------------------2O4Lymphosarcomaand other neoplasms of lymphaticand hematopoietic

tissues----------------------------------------------------------------2OO-2O3,2O5Lymphosarcomaand reticulosarcm-... -....--.........-...-----------------------2OOHodgkin’s disease---------.-------------.--------------..-----------------------2OlOther neoplasms of lymphaticand hematopoietictissues...---------------2O2,2O3,2O5

Malignant neoplasm of buccal cavity and pharynx-------------------------------l4O-l48of lip..--.---.-----------------------------------------------------------------l4oOf tongue---.-------------------------------.---.-------------------------------l4lOf other and unspecifiedparts of buccal cavity-----------------------------l42-l44Of phar~------------------------------------.-----------------------------l45-l4S

Malignant neoplasm of digestiveorgans and peritoneum,not specifiedassecondary----------------------.-----------------...........--.-.-.-150.156A,157-159Of esopha~s- .....-...---..------.------------.---.-----------------------------l5OOf stomch----------------------------------------------------------------------l5lOf antallintestine,includingduodenum-.----....-..-------.---------------------l52Of large intestine,except rectum-----........--...-----....--------------------l53Cecum, appendix,and ascending colon----------------------------------------l53.OTransverse colon, includinghepatic and splenic flexures--------------------l53.1Descending colon............................................................l53.2Sigmoid colon-----.-.----------.-------------.---------.--------------------l53.3Multiple parts of large intestine-----.--.----------------------------------l53.7Urge intestine (includingcolon), part unspecified-.--.--.-----------------l53.8Intestinaltract, part unspacified-------------------------------.----------l53.9

Of rec----------------. ---.---------------------------------------------------l54Of biliary passages and of liver (stated to be primary site)--------------------l55Liver-------------------------------.---------------.--..-------------------l55.OOther and multiple sites of biliary passages--------------------------155.1,155.8

Of liver not stated whether primary or secondary3------------------------------156AOf pancreas------------------.-----------.---------.-------..----...------------l57Of peritoneumand of unspecifieddigestiveorgans-----------------.---------l58,159

see footnotesat end of table.

* ,

Wmber of Ratio:3e~;& in c::i.(;))+

(5) (6)

35,0324,560

3587,3551,0081,7921,3181,42217,219

14,012

15,8027,5633,4124,S27

6,S00150

1,6292,2242,797

95,0795,505

17,623693

32,8114,6051,4721,1515,814

18, 1;!1,536

10,6636,5842,1124,4723,149

16,3601,691

1.0596

20.9660

*

‘fableI. Compunsntsof comparabilityratios for 15 leading causes of death and theirIMjor subcategories for comparingassignmentsby Eighth Revision with those by SeventhI&vision,based cm deaths occurring in 1966-cMI.

Eighth Revision


(1)

2, Malignant neoplasms, etc.—con,:

Malignant neoplasms of respiratorysystem-----------------------160-163

Mslignantneoplasms of breast-----l74

Malignant neopla$ms of genitalorgans-----------------------l8O-l87

Malignant neoplasms of urinaryorgsns-----------------------l88,lS9

Mslignsnt neoplasms of all other andunspecified sites----l173,190l199l99

Leukemia----------------------2O4-2O7

Other neoplasms of 1matopoietic tissues~%~%3~~8~;9

ktimatedmmber ofle;;g in

(2)

56,668

27,293

40,516

14,408

35,774

13,976

16,602

stimstedumbsr ofeaths in01. (5)hat wentto (2)

(3)

54,584

2,59720,80130,403

783

27,221

39,9697,5625,6809,092835

15,806994

13,9875,7878.20!3

31,2964,498

358i’,1371,00s1,6981,3181,36713,912

13,834

15,47E7,4973,39t4,58:

—SeventhRevisiun


(4)

Malignant neoplasm of respiratorysyetem,not specifiedassecondary---.-.-.--...-....-..-..-------.--...........---------------....-..-.l6O-l64of 1aP------------------------------------------------------------------------l6lOf bronchus and trachea, and of lung specifiedIISprimcry------------------------l62Of lung, unspecifiedas to whether prtiry or eecondary--------------------------l63of other parts of respiratory systm-----------------------------------------l6O,l64

Malignant neoplasm of breast-------------------------------------------------------l7O

Mslignsnt neoplasm of genital 0rWns-------------------------------------------l7l-l79of cervix uteri------------------------------------------------------------------l7lOf other and unspecifiedparts of utews-------------------------------------l72-l74Of ovary, fallopiantube, and broad li

F’-------------------------------------175

Of other and unspecified female genita orgcns-----------------------------------l76Of pr0state----------------------------------------------------------------------l77Of all other and unspecifiedmcle genital orgsns-----------------------------l78,l79

Malignant neoplasm of urinsry organs-------------------------------------------l8O,l8lof ki&ey------------------------------------------------------------------------18Oof bladder end ~thec Urina= ~rgann----------------------------------------------181

Malignsnt neoplasm of other and unspecifiedsites---------------------156B,165,190-199Of skin----------------------------------------------------------------------l9O,l9lOf eye----------------------------------------------------------------------------192Of brain and other parts of nervous syst---------------------------------------l9!of thyroid gland-----------------------------------------------------------------l94Of bone---.---.----.--------..-.--.----..---------------.-.--.-.-...-.---...---.-l9fof connective tissue-------------------------------------.-----------.-----------l9iOf other s ecified sites, nut stated to be secondary------------------------l95,l99A

iOf UIIspeciied sites.--------.--.--.-.----.--.-.--.-..-------------l56B,l65,l98,l99~

Leukemia and aleukmti----------.--------------------------------------------------2O~

Lymphosarcc?nsand other nsoplasms of lymphaticand hcmatopoietictissues---2OO-203,205Lymphusarcomsand reticuloaarc-------------------------------------------------2OOHodgkin’s disease----------------------------------------------------------------2OlOther neoplacms of lymphatic and hsmctupoietictis.sues-------------------202,203,205

mber of#chs in1966

(5)

54,9342,62320,91330,565

83:

27,53:

40,37f7,66:5,7319,16:86!

15,9411,01:

14,16[5,84?B,32!

35,03:4,56(351

7,35!1,0011,79:1,3111,42:17,211

14,01:

15,80;,:?

4:82

Ratio:31. (2) +Col. (5)

(6)

1.0316

0.9913

1.0034

1.0171

21.0212

0.9974

21.0506

see footnotesat end of table.

Table I. Components of comparabilityratios for 15 leading causes of death and their major subcategories for comparing assignmentsby Eighth Revision with those by SeventhRevision,based on deaths occurring in 1966--Con.

Eighth Revision


(1)

3, Cerebrovasculardiseases.-..4438438

4. Accidents---------.-------E8OO-E9&9

k.tiuatedwnber ofieathsin1966

(2)

202,898

108,68:

.

stimatedsnber of?aths in::;$(;t

:0 (2)

(3)

200,32:

8,28;109,40(62,93;19,701

106,45:

1,00C52,45E51,3731,7578,61222,29714,2024,5051,083

2921,6301,4861,8061,52316,9065,3124,8396,755

1>4321,9891,0257,813337

2,189

1,672

5,631430

1,129

5,909

Seventh Revision


(4)

Vaacular lesionsaffecting central nervous systa . . ..--------. -- . . . . . . . . .. ..----33 o-33&

Suberechnoidhmorrhage ...........................................................3~OCerebral haorrhage ...............................................................331Cerebral embolism and thrombosis'-------------------------------------------------332Other vascular leeions affecting central nervous systm .....-.-.----------..-.333.334

'ccidents-------------------;-------------------------------------------------E8oO-E962

k?ilway accidents...........................................................E8~~.E8O2MDtOr vehicle accidents-----------------------------------------------------E8lO-E835MOtOr vehicle ‘raffic accidents-------------------------------------------E8lO-E825Motor vehicle traffic accident involvingCOlliSiCXIwith railway train--...-..E810Motor vehicle traffic accident to pedestrian.--....----.--.-.........-....---E8l2Other motor vehicle traffic accidents involvingcollision-.......-.E8ll,E813.E81gMOtOr vehicle nOncOllisiOn traffic acci.ients------------------.-.-....-.E82o-E824Motor vehicle traffic accident of unspecifiednature.............-.-.-...--..E825

Motor vehicle nontrafficaccidents........................................E83O.E835

Other road vehicle accidents................................................E84O.E845Water tranaportaccident~...................................................E8~O.E858

‘ircraft accidents----""--------------------------------------------.-------E86O-E866Accidental poisoning by solid and liquid substances.....---...-.-...........E87O-E888Accidental poisoning by gaaes and VaporS....................................E8g0.EEg5Accidental fallS............................................................E~OO.E~O4

Fall frOm One level tO an0ther-----------------------------------------...E9oo.E9o2Fall on same level...--....-.--.........-......---.-------.-.-.........--------Ego3‘nSpecified '811s--------------------------------------------------------.----.E9O4

Blow from fallin or projectedobject or missile.---.---..............---------..Eg~OAccident caused %y mchinery ..............--.-.--.---......-....-------------.--.Eg~2Accident caused by electric current..-...-..-..-..........---------.---.-.-.--.--E9l4Accident caused by fire and explosionof combustiblematerial--Accident caused by hot substance

------------------E916, corrosive liquid, steam, and radiation-.--E917,E9l8

Accident caused by fiream ............-.-.-----.--.-...-.-.------------...-......Eg~g

Inhalationand ingestionof food or other object cauaing obstruction‘r 'uff0cati0n-------------------------------------------------------------E92l,E922

Accidental droming ..............................................................Eg29Excessive heat end insolation.-..--.-.............----------.--............------Eg31Complicationsdue to nontherapeuticmedical and surgical procedures,therapeuticmisadventure,and late complicationsof therapeuticprocedu=e~.-------..--.E940-E959

All other eccidenta..-...------E911,E913,E915,E920,E923-E928,E930,E932-E936,E96O-E962

*

tumberof~eathsIn1966

(5)

204,841

8,531lll,lIft663,94320,921

113,563

1,02753,04151)9331,8008,67522,64114,2914,5261,108

2921,6301,5102,2831,648

20,0665,7725,5938,701

1,4592,0701,0258,084409

2,558

1,831

5,687531

1,+11

7,001

Ratio:31. (2)+:01. (5)

(6)

0,9905

0.9570

● *

Table 1. Componentsof comparabilityy ratios for 15 leading causes of death and their major subcategories for comparing assignmentsby Eighth Revision with those by SeventhRevision.based on deaths occurrim? in 1966-Con.

Eighth Revision


(1)

4. Accidents— con.:

Motor vehicle accidents---E8lES2:2:

All otheraccidents--------ESOO-E807,E825-E94~

5. Influenzaandpneumonia----------47O-474,4SO-4S6

Mtiinatednnnberofieathsin1966

(2)

52,622

55,9s3

66,413

ktimated}mmberofIeathsin:01.(5)hat wentto (2)

(3)

52,2505:,;$;

8;57022,27414,158;,46;,

53,7711,000292

1,6301,4861,8061,52316,8785,312:,;;;

1,4051,9361,0257,78S337

2,1S9

1,672

5,431430

1,129

5,814

61,058

2,6S358,3758,56531,9495,40912,452

Seventh Revision


(4)

MOtOr vehicle aCCidentS------------------.-........--.--.--..-------------..-E8lO-E835Motor vehicle traffic accidents-------------------------------------.......E8lO.E825Motor vehicle traffic accident involvingcollisionwith railway train---------E8lOMotor vehicle traffic accident to pedestrian-----,---.-------—------....-..-.E8l2Other motor vehicle traffic accidents involvingcollision-----------ES19,E8l3-ESl9Motor vehicle noncollisiontraffic accidents-----------------------------E82O-ES24Motor vehicle traffic accidentof unspecifiednature----------.-.--.---...-..-E825

Motor vehicle nontrafficaccidents-----------------------------------------E83O-ES35

Other accidents-......---.........-....-.....-..-.--....-.-.---...-E800-E802.E84O-E962Railway accidents----------------------------------------------------------E8OO-E8O2Other road vehicle accidents-----------------------------------------------E84O-E845Water transportaccidents--------------------------------------------------E85O-E858Aircraft accidents---------------------------------------------------------E86o-E866Accidental poisoningby solid and liquid substances.-----------------------E87O-ESSSAccidental poisoningby gases and Vapors-----------------------------------E89O-E895Accidental f&llS-----------------------------------------------------------E9OO-E9O4Fall from one level to another-------------------------------------------E9OO-E9O2Fall on Same leVel----------------. -------------------- .---------------------- E9O3Unspecified falls-------------------------------------------------------------E9O4

Blow frti fallingor projectedobject or missile-.------------------------------E9lOAccident caused by machinery----------------------------------------------------E9l2Accident caused by electric current----------------------------------------.----E9l4Accident caused by fire and explosionof combustiblematerial-------------------E9l6Accident caused by hot substance,corrosive liquid, steam, and radiation---E9l7,E918Accident caused by firean------------------------------------------------------E9l9

Inhalationand ingestion of food or other object causing obstructionor suffocation------------------------------------------------------------E92l,E922Accidentaldrowning-------------------------------------------------------------E929Excessive heat and ins0lation------------------------------.------------------.-E93lComplicationsdue to nontherapeuticmedical and surgical procedures,therapeuticmisadventure,and late cnmplicaticn’tsof therapeuticprocedures----.--.-...E940.E959All other accidents-----------E911,E913,E915,E920,E923-E928,E930,E932-E936,E96O-E962

:nfluenzaand pneumonia,except pneumoniaof newborn----...-.---.....---.--.-.-.-48O.493

Influenza----------------------------------------------------------------------48O-483Fneumonia,except pneumonia of newbom-----.-----------------------------------49O-493Lobar pneumonia------------------------------------------------------------------49OBronchopnemonia----------------------------------------.--.....-....-..---------49lPrimary atypical pneum0nia----------------------------------------------------.--492Pneumonia, other and unspecified-.----..-...-...-.-..-......---------------------493

[umberofIeathsin1966

(5)

53,04151,9331,8008,67522,64114,2914,5261,108

60,5221,027292

1,6301,5102,2831,648

20,0665,7725,5938,701

1,4592,0701,0258,084409

2,558

1,s315,687531

1,4117,001

63,615—

2,83o60,7S5

8,S6433,276

5,72912,916

Ratio:

>01. (2)+Col, (5)

(6)

0.9921

0,9250

21.0440


—

Table I. componentsof comparabilityratios for 15 leadhg causes of death and their major‘subcategories for ccrnpariugaeslgnmentsby Eighth Revision tith tkse by seventhRevision, based cu deaths occurr@g in 1966-W.

Eighth Revision


(1)

5. Influenzaand pneuuonla- con.:

InfhJenza---------------------47o-474

memonia ---------------------480-486

6.

7.

8.

9.

Certain cr Ies of mortality inearly5mfancy460-769.2,[email protected],774-778

Diabetes mellitus---------------25O

kteriOsckosis----------------440

Bronchitis,emphysema,andasthma---------------------49o-493

Chronic and unqualifiedbronchitis---------------....4gO,4gl

~physma-------. -...-----------.-4g2

A2thma---------------------------493

10. Cirrhosisof liver-------------57l


Stimmedtrnberofeathe in1966

(2)

2,709

63,704

47,425

34,496

34,873

29,841

5,484

21,350

3,007

26,839

MAMtedNmdmr ofIeathsin:01. (5)bt wentto (2)

(3)

2,676

46,706

191

46,51;

33,870

32,083

28,602

4,0894,89419,619

4,851

19,555

2,623

26,203

16,9629,241

Seventh Revisiun

Cause of death rnd categorynuaber

(4)

~1U~Z6-----------------..----.-......-.....-.-.--.............-.-..-........4B@483

Yne=onia, except pnemaonia of nakm .........................................4~O.4~~L&ar pnemia ..................................................................4~OBrmchopnewb-------. ----.--.--........-...-.-..--...........-------..-.......4~~Pr2mary atypicalpntummia '-------"----------------------------------------------492Pne-ia, other and unspecified---:---------------------------------------------493

Certain diseases of early tifmcy-----------..........---..---...........----.---76O.77(

pUe~011i2 Of U~k~- .....-.----..-------.........---------...........--------.....76.

nia~h= Of n=~~----------------------------------------------------------------7&Remainder of Certain diseases of early hfmcy .......--...---..........76O.762.76~77(

Oiabetes~ellitUS---..--.-..---------.----....-.-------....-....----.-------.........26(

General arteriOsclerOsis--.-------.----....-.....-----.--...........----.-.--....--..45(

Asthma, Bronchitis,chronic and unqualified,and ~physema without mention ofbronchitis'-----------------------------------------------------------24l,5Ol,5O2,527.l

~t~~..-.--.---.-----... . . . . . . . . . . . . . . . . . .. . . . . ------------ . . . . . . . . . . . . . . . . . . . . . . .2/,,Bronchitis,chronic and unqualified'-------------------------------------------5Ol,5O2Emphysemawithout mention of bronchitis‘-----------------------------------------527.1

Bronchitis,chronic and unqualified'-------------------------------------------5Ol,5O2

Raphysaa without mention of bronchitis‘-----------------------------------------527.1

A.2t~a_____ ........................... ...----------............................241

;irrhosisof liVer-----------.-------------..-..--.-----.-.--......---..----.---.---.58~

WithQut mention of alcoholismWith alcoholism

'---------------------------------------------------58l.O'------------7-;---------"----------------------------------------58l.l

“

(5)

2,830

60,7858,8&%33,2765,72912,916

51,644

2,477250

4a,917

34597~

38,907

29,74o

4,32.45,16420,252

5,164

20,252

4,324

26,692

17,3209,372

(6)

0.9572

21.0480

20.9183

0.9971

0.8963

1.0034

1.0620

1.0542

0.6954

1.0055

, ‘I

TableI. Componentsof comparabilityratios for 15 lecding causes of death and their major subcategories for cmparing assignmentsby EighthRevision with those by SeventhI Revisim, bcsad on deaths occurringIn 1966-Con.

‘Eighth Revfsim

Cause of death and category nmbcr

(1)

I11. Suicide...-......-...--..--E95&Eg5g

12. Congenital anOmalies---------74o-759

,13. lTmicide------------------ECMO.g978

14. 17ephritisand nephrosis------58O-584

15. Peptic ulcer---....--....-..-53l.533

;sttiatetmnber 01Ieathsti1966

(2)

20,158

18,529

11.570

10,227

10,172

Sstimctedwrdmr ofieathsin;:; Wt

to (2)

(3)

20,046

5,1922,82510,0721,957

17,453

1,1251,655

8,8195,853

11.395

6,7732,3002,023298I

9,955

9,429

4,8964,533

—Seventh Revision

——-

Cause of death and categorynuuber

(4)

Suicide------------------------------------------------..---./-------------E963,E970-E979

Suicideby oisoning---------------------------.-..------..-..-.-------...--Eg7O-Eg73Rsuicide by ringingand stran@ation-- -----...-.----------------------.-------.--~974

Suicide by firearm and explosive--'----------------------------------------------E976suicide by all other manS-- . . . ...-... -... ---. ---------. --.--. -..-E963. E975.E977.E979

CongenitalmlfO~tiOns--..-- ....-.....-....-----.-.--.---.-...-----------...--75O.75g

Spire bifida and mnLngocele.-..-......-..........-..-.-..-------.-....-----------75lCongenitalhydrocephclusand other congenitaltualformticms of nervous systcm andscme Organn---------------............-.-.-.----------....---.--.---........~52 753

Congenitalmalformationsof circulatorysy8t~...-...- .....-.-...........-.-.---!7~4Other congenitalml fo~tims..----.. --..-----..--.---.-...------.-......75O.755.75g

Hmlcide-'---------------------------------------------------------------E964,E98O-E985

Assault by firearm and explosive.................................................~8lAssault by cutting cnd piercing fnsttuments.-.-.------------.---.--------.---.---E982Assault by other mccna'------------------------------------------------E964,E98O,E983Injury by iIIte~mtiOU Of police-----------.---.-...--.---.-.....-.........-.....E984EXeCUtim---------------------------...--.-.........-....-.-.------.........-...-E985

Nephritisand nqhro81s-...-..-.....-.-.--..-------....--.-...---...-....-......59&594

Acute n~~iti~-------------------------------------------------------------------59oNephritiswith edema, includingnqhrosis .........................................591~mnic and unspceiflednephritis and other renal sclerosis-------------------592-594

Ulcer of etomach and duti. ..................................................5&O.5&l

~= Of st~c~-----------------------------------------------------------------54oUlcer of duode. ................................................................54l

—

?umberofie;;& in

(5)

21,281

5,5882>86310,4072,423

18,15S

1,151

1,7569,0206,231

11,606

6,8552,3302,;::

1

11,540

;;;10,376

10,321

5,5994,722

Ratio:ali.(&+

(6)

0.9472

1.0204

0.9969.—

0.8862

0.9856

‘lSharewere no dcathe in the scqle assigned to the seventhRevieim title @& pcctoriswitkt _tim of corm~ disease (IC2)No, 420.2). NCRS 1 !ologistsstate,how-ever, that with a possible few exceptions these deatha would be assigned by the Eighth Revision to AIIgi.nnpectoris (ICM No. 413).

f the preference in the SeventhRcvisi.m of angina pectoria over cardfovaeculerdieamee.‘r%fl’r;as

Me axcaptions, if any, resulted from tbe

on. described in qendir 1, the set of Ecventh Revisim categorynumbers used to construct this ratio is differant frm the set .md to construct the previouslypublished provieioml cmparebi iry ratio for thie eam Eighth Ravisitm title.

% computing tha ahova-mentionedpublished comparabilityratio for MMNCligIUIntncopkm of liver mt stated whether rfmcry or secmdary (1~ No.

t necrplasma of digestiveorgans and peritmm (ICOA Non. 150-159), the Seventh Revision titlef%) was not incl.dad in the ... of titlee met nearly .muqmwble to Malignant neoplams of di~s-

ber 116A was thus excludad bacawe deathe aoeignedto this category by the Sevmth Revi6im were rmved b the Eighth Revision rm~fl~i% %Y%’%t%%%a%dy attacked by t~qleam (in this case,Sectkm II. NI?oPlacma”:Malignant ne~lam of other ~

ifrm un&r digestive organe and paritmcnnr) and placed under t e follcwing mbsectlon ofeCi ied sitee (ICDA Hoe. 190-199).Mre apacifically, these deethn were transfemed to the ncw Eighth Revision ti-

tle: Nali~t naoplam of liver, unspecified ICM No. 197. ).A4Therewere no deaths in tha sample aseigne to the savanthRevieim titleNali&pmnt naoplarm of mltiple pcrta of large”intestine (ICD No. 153.7).

hCWWer, that these deaths would k distributedby the Eighth Nsvisf.00over the four-digitcategmies mder ~li-t neqla~ of hrge ~te~t~m, .sxcqt rectm (ICM No.153).NCNS nosologists state,

APPENDIX II

TECHNICAL NOTES

Death Statistics

Tabulations of deaths used in this report arebased on information obtained from copies ofdeath certificates. These copies were receivedfrom the registration offices of all States, certaincities, and the District of Columbia. The sta-tistical information on these records was edited,classified, transferred to a tape for computerprocessing, and tabulated in the National Centerfor Health Statistics (NCHS).

The rates shown in this report are based ondeaths tabulated by place of occurrence, that is,aIl deaths occurring in the death-registrationStates from 1900 to 1932, and aII deathsoccurring in the continental United States there-after, with Alaska added in 1959 and Hawaii in1960. Deaths among armed forces overseas andU.S. nationals living abroad are excluded for allyears.

“Race

The category “white “ incIudes, in additionto persons reported as “white,” persons reportedto be Mexican or Puerto Rican. The categories“races other than white” or “ail other” consistof persons reported as Negro, American Indian,Chinese, and Japanese; other numerically smallracial groups; and persons of mixed white andother races.

Populatim Bases

Rates were computed on the bases of popu-lation statistics made available by the U.S.Bureau of the Census. Rates for decennial yearsare based on the populations enumerated incensuses of those years, which are taken as ofApril 1. Rates for all other years are based on

midyear (July 1) estimates. Sources of the popu-lations used, published by the Bureau of theCensus, are given below.

Vital Statistics Rates in the United States,1900-f 940, Washington, U.S. GovernmentPrinting Office, 1943.

Current Population Reports, Series P-25:

No. 98.

No. 265.

No. 276.

No. 310.

No. 321.

“Estimates of the population ofthe United States and of thecomponents of change, by age,color, and sex: 1940 to 1950,”1954.

“Estimates of the population ofthe United States, by age, color,and sex: July 1, 1950 to 1962,”1963.(Used only for data years 1961and 1962.)

“Estimates of the population ofthe United States, by age, color,and sex: July 1, 1963,”1963.

“Estimates of the population ofthe United States and compo-nents of change, by age, color,and sex: 1950 to 1960,” 1965.

“Estimates of the population ofthe United States, by age, color,and sex: July 1, 1960 to 1965,”1965.(Used only for data years 1964and 1965.)

78

.

No. 352.

No. 385.

No. 416.

No. 441,


“Estimates of the population ofthe United States, by age, color,and sex: July 1, 1964 to 1967,”1968.(Used only for data year 1967.)


“Estimates of the population ofthe United States, by- age, color,and sex: July 1, 1969,”1970.

The population estimates by color used for1962 and 1963 exclude New Jersey. Birth,

death, and fetal death records of the State ofNew Jersey did not contain the race item in thebeginning of 1962, and the certificate revisionwithout this item was used for most of 1962 aswell as for 1963. Therefore the National Centerfor Health Statistics estimated a population baseby color for these years which excluded NewJersey. The estimates for 1963 are shown intable 6-5, Part A, Volume II, of Vital Statisticsof the United States, 1963. Those for 1962 areshown in the comparable report for that year.

Rates

All rates are shown per 100,000 population.In many cases the rates are shown beyond thelast significant figure, not because they can beinterpreted with that degree of accuracy, butmerely for convenience in computation andpublication. .

.

b

79

APPENDIX Ill

THE UNITED STATES STANDARD CERTIFICATE OF DEATH,1968 REVISION

Standard certificates of death issued by theNational Center for Health Statistics and itspredecessor offices have served for many yearsas the principal means of attaining uniformity inthe content of documents used to coIIect infor-mation on deaths. They have been modified ineach State to the extent necessitated by the par-ticular needs of the State or by special provisionsof State vital statistics laws. The certificates ofmost States, however, conform closely in con-tent and arrangement to the standard certificates.

The most recent revision of the standardcertificate of death is shown on page 81. It wasprepared in close collaboration with State healthofficers and registrars; Federal agenciesconcerned with vitzd statistics; national, State,and count y medical societies; and othersworking in the fields of public health, socialwe] fare, demography, and insurance. It wasrecommended to the States for adoption as ofJanuary 1,1968. ,.

, 80

.

,

&

mcm APP80VfDW901! Wnmuno. ba-tl*ol

(P14Y51c3AF4. MEDICAL -AS41NER on cORONER)u s WV[nllmtm nl”11M6 Owlcc ln7 or-al-us

r 1 u.S. STANDARD

CERTIFICATE OF DEATHr 1

TYFE, OR PRINT IN 1-1 VIM wJN8E9MRMA@HNT lNK/oWA5m_NmE

slam m! NW1

SK Xulowou FOB,,,’, *#oou LAST S&x DATE OF DCATH t NON*.. DA,, ~ena B

Ixnwnolls ,, 1, 3.

RACE WW1l, MEOaO, AU-SCAN OND,AW AGE—uIr UNM* 1 vu, t UMDS* I OA, :;NJ OF BIRK+ I INX1., OAV, COUNTY OF DSATHMC. csncm 1 ltilTFIDA? 1 WA1$l -s, I OAW HCUR% mm.

4, %. h. I 51 I I* 7m.cilY,10W,o~10CATION OF DEATH ::CIC” :: ::lr& HOSPmAL OR omm NSTMJT10F4-NmE <t? WI 1. tlWE%am sQsL?NO *WC* 1

-.

n, ?,, N.STATE OF URIN t If NOI In ..s..., nut CITW.EN OF W*T Cou~y MARRIED. NWFiR IAABRIED, SURVW- =SE 1IF WWC, OIVI MAWIN w )

Cwwm? ) WIDOWED, DIVORCED [ UICUYIUSUALC?soclfcr t *. 1,. 11.WIRU oU,MfDIWW. :9 Oum SOCIAL SECURITY MJMEER USUAL CCCU?ANC44 {OIVERIND0S WU C--E 0-1.0 ~= 0~occumo 1.

MEW OF EuS!NESS OR lNDUSIRYWOuwa we, WIN If ErJltw I

IN W8TIJWON. OmUUDRNC1 won 12, ISO, Isb.

.Dlus,,o”. RESIDENCE-STATE COUNTY CITY, TOWF4, OR LCKATIQN ON*,W cm L“- STREET AND NUMBER1$mclrr ,1s on no I

r4d. 14,.

FATHER—NAME *OW Uloml utr MOTNER-A4MUEN NAME SIW *WMR M$l

14.

INFORMANT-NAME AWLINO ADDRESS {mm 0, 1.F.D. No.. cm m 10WN, SrAIt, Zl?l

[ENTER ONLY ONE CAUSE FER tJNE FOR (o), (b), AND {<)]

11,

CERTINCATW4— -H OA~ ~ I *m OAV ‘Uc A?lD&S~$AW HL&lB AW7nm 8 Dmlolo ml Ww ~ DEATH OCCURRED Al We PI&Z], G+J IIUPHYSICIAN: TO

wOY ~mt DUm. [ now, Mm, AND, m m{ IE$rI mmwm me

n,. DtCIASED PROM tllb. 21< Ild~ ,% # W,:;:?

n*.

CERTlflCAT!OF4-MEDtCAL WNEI OR CQROUEE: on WE DAMS w TM HOUR OF M*T!I 7He Dx-&:7 ‘~ ‘-wm~,tn WA* -U:XAMINAnON of nu mm AND/Oa w lt4v1S1mA:0N, IN tir OmNlm+:I#i OCCUCIY.O ~ IUf Mm AND OM 70 MC CAUXU1 %lAIID

ma

M. m M<CERTIFIER—NAME mm ok ?U?tn i SIGN ANRE DIGuf a llrti 10 A7E SIGN ED {mm, DAY,-1

mMAkNG ADDRESS-CERTIFIER SIWR1 01 R.*.D No. cm on 1W14 UA?l ZIP

IURIAL. CREMATION, REMGVA1 CWETERY OR CREMATORY-NAF4J LOCATION camon IOwN SIAm[ Smclm 1

24*, E4b. 14,.DATE 1MOIml, OAT, mm 1 FUNERAL HOME-NAME AND ADDRESS 1 SIMIT OR 8.?.0. NO.. CM OR tOW”, STATE, ZIP I

244. 2s9FU4ERAL DIRECfOR-SIGNATURE I ffilSTRAR-SlU4A1URE I DAm MECOVEO w ml XEOI$lRAR

1

2s I* 1*

81

APPENDIX IV

BRIEF SUMMARY OF STATISTICAL DESIGN

General Plan for Deaths at All Ages

The strata, corresponding to the causes orgroups of causes of death according to theSeventh Revision, into which the total numberof deaths in 1966 are divided for the purposes ofthis report, are designated by L; the totalnumber of deaths in 1966, by l?; and thenumber of deaths in the general or &th stratum,by N~. Therefore,

(1)N=f Nh =N1+N2+ . ..+jV+NL. +NL.

h

Similarly, the strata according to the EighthRevision are designated by L’; and the numberof deaths in the general or ~’th stratum, by N;,.Thus, according to the Eighth Revision, the totalnumber of deaths in 1966 may be represented asfollows:

(2)N=$V’, =N;+N:+ . ..+.’+ N.. +N’ .

hh h L’

Let the number in the stratum according to theEighth Revision to which the &th stratumaccording to the Seventh Revision is most nearlycomparable be designated by N~,. Then theequation for the comparability ratio (designatedby Rht ) that is to be estimated is:

N’,R,=L

h Nh(3)

Let the estimatethe estimate of

of Rht be denoted by r~?; andN:, be denoted by xL,. Inas-

much as N~ is kno~n, the problem of o~tainingan estimate of RhI reduces to the problem of

obtaining an estimate of Nj. This estimate r~~may be defined as follows:

(4)

To obtain the estimate x;,, L random sub-samples were drawn by the computer from theL strata into which the total number of deathsin 1966 were divided according to classificationby the Seventh Revision. These L random sub-samples were then classified according to theEighth Revision.

The size of the random subsample drawnfrom the &th stratum of N is denoted by n~; andthe size of the stratified random sample drawnfrom all deaths in 1966, classified according tothe Seventh Revision is:

n=inh.h

(5)

The number of deaths in the stratum accordingto the Eighth Revision to which the Ath stratumof the stratified random sampIe n, according tothe Seventh Revision, is most nearly com-parable, is designated by n.;,; and the totalnumber of deaths at all ages drawn in the strat-ified random sample, classified according to theEighth Revision, is designated by n’. Thus, n’may be represented as follows:

I

n’ = ~, n’hth

where Lt designates the strataaccording to the Eighth Revision.

(6)

in the sample

82

.

.

.

\

Estimator of the numerator. –Inasmuch asthe denominators of these comparability ratios{defined in equation 3) are the total counts of

\deaths in the stratum in 1966 according to the~Seventh Revision, the only values estimated‘from the stratified random sample (n) are, asstated above, the numerators—the numbers ofdeaths that would be assigned to each of thestrata if all deaths in 1966 were classified by theEighth Revision. The estimator of these numera-tors is represented as follows:

Nhxh Nixix’.=— +i —

h’ nh j#h 72.J

where Xh is the number of deaths in the ~thstratum of the sample—the stratum according tothe Seventh Revision selected as most nearlv

~comparable to the &’th stratum of the EighthRevision, and where ~j represents the number of

~deaths in any except the hth stratum of thestratified random sample th~t were coded to the

~~’th stratum by the Eighth Revision. The total

I

number of strata other than the &th that con-tained deaths that were assigned to the L’thstratum by the Eighth Revision is represented by

1J ‘h

In equation 7 Xh=

1

Z x~i, where x~, takes on1=1

the value 1 if the death it represents was.assigned by the Eighth Revision to stratum N’~?;and takes on the value O if the death it repre-sents was not assigned to stratum N’~~.

n.

Similarly, in equation 7 xj=J~l Xji >where Xji takes

on the value 1 if the death it represents wasassigned to stratum N~l; and takes on the valueO if the death it represents was not assigned tostratum N; t.

Variance of the numerator. –The variance ofx’~~, the estimated total of deaths that are codedby the Eighth Revision to the category numberscomprising N~J, 11 is:

0; s; S,2 (8)xht=N: (1 -f, ) — +J+rjz(1-~)+;

‘h ‘ j

where f~ is the sampling fraction (n~ /N~), and Jis the sampling fraction (nj/Nj ). For a variate,such as in this study, that takes on only thevalue O or 1,

S: =NhPh Qh/(Nh - 1), (9)

where P~ is the proportion of deaths in N thatAwould take on the vake 1, that is, that wo d be

assigned to iv’~, if coded by the Eighth Revision,and where Qh= 1- P~. The sample variance forstratum ~ may be expressed as follows:

‘; =(nhphqh)/(nh- 1).(lo)

Similarly, the sample variance for the generalterm among all the strata in the stratifiedrandom sample that include deaths assigned tostratum h‘ by the Eighth Revision may bewritten:

‘:* (njPj9j)/(nj - 1)- (11)

Substituting the right-hand members of equa-tions 10 and 11 for S2 and S;, respectively, inequation 8 gives the i!ollowing as the estimate

~2

from the samp]e of “hl :(12)

‘h (Nh- ‘~) Nj(Nj -+ ‘ ‘S:r = (PNh)+i (Pj9j).

h’ nh-l j#h 7Zj - 1

Inasmuch as ph = (x~/nh); qh= 1 ‘Ph; Pj= (xj/n, );

and qj = 1 -pj, we have

(13)

Nh(Nb - nh ) Xh

(

x;S:l , = —.

)+

h rzh Uh - 1 r2h(nh - 1)

N, (NJ - ni ) Xj

(X2

i J—-j#h ?lj nj-l )nj(nj-l) “

St andarcl error of the estimate of tileratio. - Inasmuch as the vzariancc of a constanttimes a random variable is the constant squared

times the variance of the rfidom variable, it~follows that

2122

s.~ th ()= ~ %’

(14)

Taking the square root of the above equationgives the estimated standard error of r~,,denoted s,~,:

Confidence interval for the ratio. –Once thestandard error of the estimate of the compara-bility ratio (denoted sr~~ is known, confidence

intervals for Rhl$me ‘me ‘due ‘f ‘e cOmp=a-bility ratio as defined in equation 3 may becomputed. The required degree of confidencethat a range will cover the true value of R ~, hasbeen specified for this study to be 95 percent.

Employing the usual notation in the tablefor the normal distribution 12 it may be stated

that for given perc~ntage p (equal to 5 percentin the present study) the pYo value Ap of thenormal distribution is defined by the condition:

P (16)Probability (lrhJ-Rht I >hp s, , ) = —

h 100 “

With the 5-percent value ?Lp of the normaldistribution equal to 1.9600 this gives:

rh~-1.9600 s, , <Rht <rhI + 1.9600 s, , .h h

To illustrate, let r~,=1.1852; and Sr ,=0.0406.This gives the relation: h

(rhl - 1.9600s, , ) < RhI < (rhI+ L9600s,h,);h

or 1.1056 <Rh I<1.2648.

Thus, we have two positive numbers (1.1056,1.2648) such that the probability that the truevalue of Rht is included in the interval definedby them is 95 percent.

84

APPENDIX V

COMPARABILITY RATIO FOR MAJOR CARDIOVASCULAR DISEASES

A comparability ratio frequently requested* is that for Major cardiovascular diseases (ICDA

Nos. 390-448). This group title includes & ofthe titles in “Section VII. Diseases of the circula-tory system” of the Eighth Revision except the

* folIowing one: Diseases of veins and Iymphaticsand other diseases of circulatory system (ICDANOS. 450-458).

The most nearly comparable group title inthe Seventh Revision is Diseases of cardiovascu-k system (ICD Nos. 330-334, 400-468).

Both of these group titles include the firstand third leading causes of death—Diseases ofheart (ICDA Nos. 390-398,402,404, 410-429)and Cereb rovas cuktr diseases (ICDA Nos.430-438). They also both include Diseases ofarteries, arterioles, and capillaries (ICDA Nos.440-448). The comparable title in the SeventhRevision for these latter diseases is Diseases ofarteries (ICD Nos. 450-456). But the group title

Diseases of cardiovascular system (ICD Nos.330-334, 400-468) in the Seventh Revisionincludes also the title Diseases of veins and otherdiseases of circulatory system (ICD Nos.460-468). These diseases of veins and otherdiseases of circulatory system (assigned by theEighth Revision to ICDA Nos. 450458) are notincluded, however, under the Eighth Revisiongroup title Major cardiovascular diseases (ICDANOS. 390448).

The exclusion of these diseases (ICDA Nos.450-458) from the Eighth Revision group titleMajor cardicwascular diseases is the primaryreason that the comparability ratio for these twomajor group titles is less than 1.00.

The comparability ratio of

8th ICDA NOS. 3904487th ICD NOS. 330-334,400468 = 0“9853”

85

APPENDIX VI

NOTES FOR USE IN PRIMARY MORTALITY CODING FORTHE EIGHTH REViS10N6”

When a condition in one of the categories shown in the following listis reported as a cause of death, the provisions of the relevant note shouldbe applied. Notes dealing with the linkage of conditions appear at thecategories from which the combination is excluded.

011 Pulmonary tuberculosis

Excludes with conditions in 515 (Pneumoconiosis due to silica andsilicates) (010).

012.3 Tuberculous laryngitis012.9 Other respiratory tuberculosis013-017 Tuberculosis of other organs

Excludes with conditions in 011 (Pulmonary tuberculosis) (011)unless reported as the underlying cause of and with a specified durationexceeding that of the condition in 011.

018 Disseminated tuberculosis

Excludes with conditions in:011 (Pulmonary tuberculosis) (011)013 (-Tuberculosis of meninges and central nervous system) (013)

035 Erysipelas037 Tetanus038 Septicemia

Code to these diseases when they follow vaccination or a slight injury(any condition inN91O-N918, prick, splinter, minor cut, puncture (exceptof trunk), bruise or contusion of superficial tissues or external parts, burnof first degree); when they follow a more serious injury, code to theinjury.

196 Secondary and unspectjied malignant neoplasm of lymph nodes197 Secondary malignant neoplasm of respiratory and digestive systems198 Other secondary malignant neoplasm

Not to be used if the site of the primary neoplasm is known.

292-294 Psychosis associated nith physical conditions309 Mental disorders not specl~ed as psychotic associated with physical

conditions3 !O-315 Mental retardation

Not to be used if the underlying physical condition is known.

303 AlcoholismIExcludes with conditions in 571.9 (Other cirrhosis of liver) (571.0).

86

323 Encephalitis, myelitis, andencephalomyelitis

Not to be used if the antecedent condition is known:

postchickenpox encephalitis (052)postmeasies encephalitis (055)otitic encephalitis (381.9)influenza] encephalitis (474)

345 Epilepsy

Includes accidents resulting from epilepsy.Excludes epilepsy due to trauma (code to appropriate N and E cate-

gories; if the nature of injury is not known, code to N854).

379 Blindness388 Deaf mutism389 Other deafness

Not to be used if the antecedent condition is known.

397 Diseases of other endocardial structures

Excludes with condition in:394 (Diseases of mitral valve) (394)395 (Diseases of aortic valve) (395)396 (Diseases of mitral and aortic valves) (396)

400-404 Hypertensive disease

Excludes with conditions in 410-414 (Ischaemic heart disease) (410-414 with 4th digit .0).

401-404 Hypertensive disease not specified as malignant

Excludes with conditions in 400 (Malignant hypertension) (400).

401 Essential benign hypertension

Excludes with conditions in:430-438 (Cerebrovascular disease) (430-438 with 4th digit .0)427 (Symptomatic heart disease) (402)428 (Other myocardial insufficiency) (402)429 (Ill-defined heart disease) (402)580-583 (Nephritis and nephrotic syndrome) (580-583)584 (Renal sclerosis unqualified) (403)

and when reported as the underlying cause of conditions in 424(Chronic disease of cmdocardium) (424)

402 Hypertensive heart disease

Excludes with conditions in:403 (Hypertensive renal disease) (404)584 (Renal sclerosis unqualified) (404)

403 Hypertensive renal disease

Excludes with conditions in:402 (Hypertensive heart disease) (404)427 (Symptomatic heart disease) (404)428 (Other myocardial insufficiency) (404)429 (Ill-defined heart disease) (404)

411 Other acute and subacute forms of ischaemic heart disease412 Chronic ischaemic heart disease

87

413 Angina pectorisExcludes with conditions in 410 (Acute myocardial infarction) (410)

424 Chronic disease of endocardium

When more than one valve is mentioned, priority in classification isin the order mitral, aortic, other.

426 Pulmorrary heart disease

Not to be used if the underlying pulmonary condition is known(except for the term “ kyphoscoliotic heart disease “).

427 Symptomatic heart disease428 Other myocardial insufficiency429 Ill-defined heart disease

Excludes with:malignant hypertension (400.1)hypertension, benign or unspecified (402)conditions in 410-414 (Ischaemic heart disease) (410-414)

428 Other myocardia! insujliciencyExcludes with arteriosclerosis (412)

429 Iii-defined heart diseaseExcludes with conditions in 519.1 (Acute oedema of lung) (427.1)

430-438 Cerebrovascular diseaseExcludes with malignant hypertension (400.2)

437 Generalized ischaemic cerebrovascular diseaseExcludes with conditions in 430-434 (Cerebral hemorrhage and

infarction) (430-434)and when reported as the underlying cause of conditions in 342

(Paralysis agitans) (342).

440 Arteriosclerosis

Excludes with conditions in:400-404 (Hypertensive disease) (400-404)410-414 (Ischaemic heart disease) (410-414)430-438 (Cerebrovascular disease) (430-438)428 (Other myocardial insufficiency) (412)445.9 (Gangrene not elsewhere classified) (445.0)

and when reported as the underlying cause of conditions in:342 (Paralysis agitans) (342)424 (Chronic disease of endocardium) (424)441-444 (Other diseases of arteries and arterioles,446 } except gangrene) (441-444, 446)584 (Renal sclerosis unqualified) (403)

and of the terms nephritis (chronic) (interstitial) and Bright’s disease(chronic) in 582, 583 (403).

460 Acu[e nasopharyngitis465 Acute upper respiratory infection of multiple or unspect~ed sites

Excludes when reported as the underlying cause of serious conditionssuch as meningitis (320), brain abscess (322), otitis media, mastoiditis(381-383), influeflza (470-474), pneumonia (480-486), bronchitis (490,491), acute nephritis (580).

490 Bronchitis, unquall~ed

Excludes with conditions in 492 (Emphysema) (491).

88

492 Emphysema

Excludes with conditions in 490, 491 (Bronchitis, chronic or unquali-fied) (491).

493 Asthma

Excludes with condition in:466 (Acute bronchitis and bronchiolitis) (466)490 (Bronchitis, unqualified) (490)

,491 (Chronic bronchitis) (491)492 (Emphysema) (492).

515 Pneumoconiosis due to silica and silicates

Excludes with conditions in011 (Pulmonary tuberculosis) (010).

519.1 A cure oedema of lung

Excludes with conditions in:429 (Ill-defined heart disease) (427.1)782.4 (Acute heart failure, undefined) (427.1).

580-584 Nephritis and nephrosis

Excludes with malignant hypertension (400.3).

580 Acute nephritis

Excludes when reported as the underlying cause of conditions in 582(Chronic nephritis) (582).

584 Renal sc!erosis unqualt~edExcludes with conditions in:

401 (Essential benign hypertension) (403)402 (Hypertensive heart disease) (404)403 (Hypertensive renal disease) (403).

593.2 Other renal diseaseExcludes renal disease NOS and renal failure NOS with:

hypertension, benign or unspecified (403).

606 Sterility, male628 Sterility, female

Not to be used if the causative condition is known.

630 infections of genital tract during pregnancy631 Ectopic pregnancy

Includes deaths from these causes even thoughbefore death.

632 Hemorrhage of pregnancy

delivery occurred

Excludes deaths occurring after onset of Iabour (651). If there is noinformation as to delivery before death, it may be assumed that deliveryoccurred and that the condition complicated delivery,

633 Anaemia of pregnancy

89

635-639 Urinary infections and toxaemias of pregnancy and the puer-perium

Includes deaths from these causes even though delivery occurredbefore death.

636 Renal disease arising during pregnancy andthepuerperium

Excludes with conditions in:637.0 (Pre-eclampsia) (637.0)637.1 (Eclampsia) (637.1).

640 Abortion induced for medical indications

Not to be used if the complication of pregnancy or other conditionrequiring induction is known.

655 Delivery complicated by jbetopelvic disproportion

Excludes with conditions in 654 (Delivery complicated by abnormalityof bony pelvis) (654).

656 Delivery complicated by malpresentation of foetus

Excludes with conditions in 655 (Delivery complicated by foetopelvicdisproportion) (655).

71I Acute non-pyogenic arthritis

Not to be used if the antecedent condition is known.

735 Curvature of spine

Excludes with conditions in:427.0 (Congestive heart failure) (426)427.1 (Left ventricular failure) (426)429 (Ill-defined heart disease) (426)782.4 (Acute heart failure, undefined) (426).

764-768 Di@cuIt labour

Excludes residual cerebral paralysis at age 4 weeks or over (343).When more than one type of difficult Iabour is mentioned, priority in

classification is in the order 764-768.

770 Conditions of placenta771 Conditions of umbilical cord772 Birth injury without mention of cause774 Haemolytic disease of newborn with kernicterus

Excludes residual cerebral paralysis at age 4 weeks or over (343).

776 Anoxic and hypoxic conditions not elsewhere classified

Excludes residual cerebral paralysis at age 4 weeks or over (343).Excludes with conditions in 760-771 (Maternal conditions, Difficult

labour, Conditions of placenta and cord) (760-771).

777 Immaturity, unquaIiJed778.1 Post-maturity779.0 Maceration

Not to be used if any other cause of perinatal mortality is reported.

90

782.4 Acute heart failure, undefinedExcludes with conditions in 519.1 (Acute oedema of lung) (427\ l).

792 UraemiaI

Excludes with malignant hypertension (400.3).

E930, E931 Complications and misadventures in therapeutic proceduresNot to be used if the condition for which the treatment was given is

known.

N800-N803 Fracture of skullWhen more than one site is mentioned, priority in classification is in

the order base, vault, other.

N995 Certain early complications of traumaNot to be used if the nature of the antecedent injury is known.

N997-N999 Complications of medical careNot to be used if the medical care was for purposes of treatment and

the condition for which the treatment was given is known.

91

APPENDIX Vll

ASSIGNMENT BY THE EIGHTH REVISION OF DEATHS THAT BY THESEVENTH REVISION WERE ASSIGNED TO MALIGNANT NEOPLASM

OF OTHER AND UNSPECIFIED SITES (ICD NO. 199)

During the period in which the SeventhRevision was in use (1958-67) NCHS divided theabove title into two parts: (1) Malignant neo-plasm of other specified sites, not specified assecondary (category number 199A), and(2) Malignant neoplasm with prima-y site notindicated (category number 199.J3).

In accordance with the procedures in effectwith the Eighth Revision, it is assumed thatmost of the deaths assigned to 199A by theSeventh Revision went into the new four-digitcategory title MaIignant neoplasms of ill-definedsites, other (ICDA No. 195.9).

The listed inclusion terms (arm NOS, chestwall NOS, ear NOS, etc.) under Eighth RevisionICDA No. 195.9 (Malignant neoplasms of ill-defined sites, other) are also shown under theSeventh Revision titIe Malignant neoplasm ofother specified sites, not specified as secondary(category number 199A). Consistent with theassumption that the above-described transferwas made with few, if any, exceptions is the factthat in 1967 there were 980 deaths assigned tothe Seventh Revision title corresponding ,to cate-gory number 199A, and in 1968 there were 905deaths assigned to the Eighth Revision titlecorresponding to ICDA No. 195.9.

On the other hand, deaths assigned to cate-gory number 199B by the Seventh Revisionwere distributed by the Eighth Revision over anumber of titles. For the purpose of this analysisthese titles have been divided into five groups.

The first four of these, together with thenumber of deaths in 1968 that were assigned tothem by the Eighth Revision (including thosetransferred to them from 199B), are as follows:

+

(1) Malignant neoplasm without specification of’site (ICDA No. 199), 9,743 deaths; (2) Othersecondary malignant neoplasms (ICDA No. ●

198), 2,304 deaths; (3) two components underthe title Malignant neoplasm of ill-defined sites(ICDA No. 195)–Abdomen, intra-abdominalcancer (ICDA No. 195.0), 1,439 deaths; andPelvis, pelvic viscera, rectovaginal septum (ICDANo. 195.1), 347 deaths; and (4) four com-ponents under Secondary malignant neoplasmsof respiratory and digestive systems (ICDA No.197 ) —Small intestine, including duodenum,specified as secondary (ICDA No. 197.4), 7deaths; Large intestine and rectum, specified assecondary (ICDA No. 197.5), 41 deaths; Peri.,toneum, specified as secondary (ICDA No,,197.6), 108 deaths; and Other digestive organs,,specified as secondary (ICDA No. 197.9), 42deaths. Based on a comparison of coding pro-cedures and inclusion terms in the Seventh andEighth Revisions, it is believed that most of the .t

deaths assigned by the Eighth Revision to thesefour groups of titles had been assigned by theSeventh Revision to Malignant neoplasm with,primary site not indicated, category number

?

199B.The fifth group of causes into which Malig-

nant neoplasm with primary site not indicated(category number 199B) was assigned by theEighth Revision is a group of additional titlesscattered over titles for other malignant neo-plasms. The broad groups under which thesetitles are included, together with the estimatednumber of additional deaths from 199B assignedto them, are summarized below.

The assumption made in obtaining this esti-

92

—..—..

T-—.———

Estimated additional deaths from

Cause of death (Eighth Revision, International

F

category number 188B

Classification of Diseases, Adapted, 1 %5)1886

...--— —Number

.—

Total . . ... .. .. .. ... ... .... . ... .. . . .. . ... .. ... .. ..... . . .... ..... . . .... .. . ...I

1,928

Malignant neoplasms of buccel cavity andpha~nx .... .. . ... .. . ..... .. . . .... . .. .. . ..... . .. ... . .. ... .. ... .. ..l4O.l4g 415

Malignant neoplasms of digestive organs and~ritoneum .. .. .... . .. ... .. . ..... . .... . .... .. .. .. . .. . ... .. . .. . ..l 50-159 727Malignant neoplasms of breast .... . .. ... . ... ... .. . .. .. .. .. ...174 44Malignant neoplasms of genital organs .. . .. ... .....l 80-187 208Malignant neoplasms of urinary orgens . .. .... .. ...l 88,189 193Malignant neoplasms of all other and unspecifiedsites . ... ... .. ... ... .. .... ... .... . . ... . .. ... . ... .... .. . 170-173,190-193 341

——Percent

100.0

21.5

37.72.3

10.810.0

17.7

1858 .

2,272

489

85752

245227

402

mate of 2,272 deaths was that this group ofadditional deaths constituted about the samepercentage of the total deaths in 1968 thatwould have been assigned to Malignant neoplasmwith primary site not indicated (category num-ber 199B) as was the proportion estimated inthe comparability study for 1.966 (13.93 per-cent ). It was further assumed, as indicatedabove, that the percentage distribution overbroad groups of malignant neopksms of these2,272 deaths was about the same as the distribu-tion of the 1,928 deaths in the comparabilitystudy.

In the above estimates based on the samplestudy, no deaths assigned by the Seventh Revi-sion to ‘category number 199B are shown tohave been transferred to MaIignant neoplasms of

i respiratory system (ICDA Nos. 160-163). Thereis considerable evidence that few, if any, deathsin 1966 assigned by the Seventh Revision to ICDNo. 199B were assigned by the Eighth Revision

* to ICDA Nos. 160-163. (It should be noted,however, that two instances in a sample of 99deaths in 1966-71 have been recorded of cer-

tificates coded to ICD N-o. 199B by the SeventhRevision and to ICDA No. 162 by the EighthRevision. 13)

In 1968 a total of 815 deaths were assignedto secondary malignant neoplasm of respiratorysystem (ckssified to ICDA Nos. 197.0-197.3).Most of these deaths could have come only fromMalignant neoplasm of thoracic organs (second-ary) (ICD No. 165) and from ICD No. 199B.Inasmuch as there were 2,116 deaths assigned toICD No. 165 in 1967, it may be assumed thatabout the same number would have beenassigned to this category in 1968 if the SeventhRevision had been in use. Moreover, in 1968only 815 deaths were assigned to ICDA Nos.197.0-197.3. Most, if not all, of these deathsmust have been assigned by the Seventh Revi-sion to ICD No. 165 or 199B. It follows, there-fore, that the difference between 2,116 and 815( 1,301 deaths) is the estimated minimumnumber of deaths in 1968 that were coded bythe Seventh Revision to ICD No. 165 and by theEighth Revision to ICDA Nos. 160-163.

93

* U. S. GOVERNMENT PRINTING 0FFICE:19E7- 191-332:50374

VITAL AND HEALTH STATISTICS PUBLICATION SERIES

originally Public Health Service Publication No. 1000

Series 1. Programs and collection procedures. —Reports which describe the general programs of the NationalCenter for Health Statistics and its offices and divisions, data collection methods used, definitions,and other material necessary for understanding the data.

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