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Abstract
Recent increases in infectious disease mortality and concern about emerging infections
warrant an examination of longer-term trends.
To describe trends in infectious disease mortality in the United States during the
20th century.
Descriptive study of infectious disease mortality in the United States. Deaths due
to infectious diseases from 1900 to 1996 were tallied by using mortality tables. Trends
in age-specific infectious disease mortality were examined by using age-specific death
rates for 9 common infectious causes of death.
Persons who died in the United States between 1900 and 1996.
Crude and age-adjusted mortality rates.
Infectious disease mortality declined during the first 8 decades of the 20th century
from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980. From 1981 to 1995,
the mortality rate increased to a peak of 63 deaths per 100000 in 1995 and declined
to 59 deaths per 100000 in 1996. The decline was interrupted by a sharp spike in mortality
caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was particularly
rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza were responsible
for the largest number of infectious disease deaths throughout the century. Tuberculosis
caused almost as many deaths as pneumonia and influenza early in the century, but
tuberculosis mortality dropped off sharply after 1945. Infectious disease mortality
increased in the 1980s and early 1990s in persons aged 25 years and older and was
mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in 25-
to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza deaths
among persons aged 65 years and older. There was considerable year-to-year variability
in infectious disease mortality, especially for the youngest and oldest age groups.
Although most of the 20th century has been marked by declining infectious disease
mortality, substantial year-to-year variation as well as recent increases emphasize
the dynamic nature of infectious diseases and the need for preparedness to address
them.