Recent Infectious Disease Mortality Trends in the United States

Abstract

Importance: Infectious diseases present an ever-changing threat to public health. Analysis of pathogen-linked mortality trends is elucidatory to infectious disease burden. Objective: To describe major shifts in United States infectious disease mortality trends from 1900-2013 with emphasis on recent changes for1980-2013. Design: Ecological study of infectious disease mortality in the United States. Setting: Infectious disease deaths were summed from Vital Statistic Reports from 1900-1967. Infectious disease deaths from 1968-2013 were extracted from the Centers for Disease Control and Prevention Wonder database and tallied. Participants: Deaths among United States residents from 1900-2013. Main Outcome Measures: Crude and age-adjusted mortality rates for key infectious diseases including emerging infections, specifically human immunodeficiency virus and certain vector-borne diseases, re-emerging diseases, specifically, vaccine-preventable diseases and pathogens with drug-resistant strains, and newly defined infectious diseases such as cervical cancer due to human papilloma virus. Results: While human immunodeficiency virus mortality has been declining since 1995 (average annual percent change = 10.6%, 95% Confidence Interval (CI) [-13.1, -7.9]), recent years have seen an increase in infectious disease mortality related to vector-borne diseases. Specifically, with the emergence of West Nile virus in the United States, vector-borne disease mortality increased from 34.5 deaths per year (1980-2001) to 141.7 deaths per year (2002-2013). Vaccine preventable disease mortality continues to decrease with an average annual percent change of 2.4%, 95% CI [-2.8, -2.0] from 1980-2013. Mortality due to drug-resistant strains of infectious diseases is increasing at an average annual percent change of 0.8%, 95% CI [0.1, 1.6] from 1980-2013. Finally, mortality due to a disease previously not classified as infectious, cervical cancer, has been decreasing at an average annual percent change of 1.4%, 95% CI [-1.7, -1.1] since 1980. Conclusions: Despite the overall downward trends in infectious disease mortality, they still account for 43 per 100,000 deaths annually in the United States. Specific diseases and disease groups evaluated in this study show inconsistent, but concerning, trends across emerging, re-emerging, and newly defined infectious diseases, indicating that infectious diseases remain a public health concern.