This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (103)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Viral Infections  • Alert me on articles by topic

Gregory L. Armstrong, MD; Laura A. Conn, MPH; Robert W. Pinner, MD

JAMA. 1999;281:61-66.

Context  Recent increases in infectious disease mortality and concern about emerging infections warrant an examination of longer-term trends.

Objective  To describe trends in infectious disease mortality in the United States during the 20th century.

Design and Setting  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.

Subjects  Persons who died in the United States between 1900 and 1996.

Main Outcome Measures  Crude and age-adjusted mortality rates.

Results  Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100,000 in 1900 to 36 deaths per 100,000 in 1980. From 1981 to 1995, the mortality rate increased to a peak of 63 deaths per 100,000 in 1995 and declined to 59 deaths per 100,000 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.

Conclusions  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.

Author Affiliations: National Foundation for Infectious Diseases, Centers for Disease Control and Prevention, National Center for Infectious Diseases (Dr Armstrong), and the Centers for Disease Control and Prevention, National Center for Infectious Diseases, Atlanta, Ga (Ms Conn and Dr Pinner).

RELATED LETTERS

Exposure to Pets in Childhood and Risk of Atopic Disorders
Thomas A. E. Platts-Mills, Elizabeth Erwin, Judith Woodfolk, and Richard Sporik
JAMA. 2003;289(7):842-843.
EXTRACT | FULL TEXT  

Lifestyle Modifications to Prevent Hypertension
Michael McGuffin
JAMA. 2003;289(7):843.
EXTRACT | FULL TEXT  

Risk of Cutaneous Vaccinia From Health Care Workers Who Receive Smallpox Vaccine
Leonard A. Mermel
JAMA. 2003;289(7):844-845.
EXTRACT | FULL TEXT  

RELATED ARTICLE

January 6, 1999
JAMA. 1999;281(1):101-102.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Trends in Recorded Influenza Mortality: United States, 1900-2004
Doshi
Am. J. Public Health 2008;98:939-945.
ABSTRACT | FULL TEXT  

Markers of treatment failure in hospitalised community acquired pneumonia
Menendez et al.
Thorax 2008;63:447-452.
ABSTRACT | FULL TEXT  

Animal models of human pneumonia
Mizgerd and Skerrett
Am. J. Physiol. Lung Cell. Mol. Physiol. 2008;294:L387-L398.
ABSTRACT | FULL TEXT  

Acute Lower Respiratory Tract Infection
Mizgerd
NEJM 2008;358:716-727.
FULL TEXT  

Infectious Disease Hospitalizations Among Infants in the United States
Yorita et al.
Pediatrics 2008;121:244-252.
ABSTRACT | FULL TEXT  

White Blood Cell Count and Mortality in the Baltimore Longitudinal Study of Aging
Ruggiero et al.
J Am Coll Cardiol 2007;49:1841-1850.
ABSTRACT | FULL TEXT  

Economic evaluation of adherence to treatment guidelines in nonintensive care pneumonia
Menendez et al.
Eur Respir J 2007;29:751-756.
ABSTRACT | FULL TEXT  

An in vitro Shwartzman reaction-like response is augmented age-dependently in human peripheral blood mononuclear cells
Motegi et al.
J. Leukoc. Biol. 2006;79:463-472.
ABSTRACT | FULL TEXT  

Antimicrobial Stewardship Programs in Health Care Systems
MacDougall and Polk
Clin. Microbiol. Rev. 2005;18:638-656.
ABSTRACT | FULL TEXT  

The AIDS epidemic in the city of Copenhagen, Denmark: Potential years of life lost and impact on life expectancy
Johansen et al.
Scand J Public Health 2005;33:222-227.
ABSTRACT  

Age-dependent health status and song characteristics in the barn swallow
Garamszegi et al.
Behav Ecol 2005;16:580-591.
ABSTRACT | FULL TEXT  

CD27+ (memory) B cell decrease and apoptosis-resistant CD27- (naive) B cell increase in aged humans: implications for age-related peripheral B cell developmental disturbances
Chong et al.
Int Immunol 2005;17:383-390.
ABSTRACT | FULL TEXT  

A Potential Decline in Life Expectancy in the United States in the 21st Century
Olshansky et al.
NEJM 2005;352:1138-1145.
ABSTRACT | FULL TEXT  

Emergence and Persistence of Macrolide Resistance in Oropharyngeal Flora and Elimination of Nasal Carriage of Staphylococcus aureus after Therapy with Slow-Release Clarithromycin: a Randomized, Double-Blind, Placebo-Controlled Study
Berg et al.
Antimicrob. Agents Chemother. 2004;48:4183-4188.
ABSTRACT | FULL TEXT  

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome
Menendez et al.
Thorax 2004;59:960-965.
ABSTRACT | FULL TEXT  

The Transformation Of Child Health In The United States
Wise
Health Aff (Millwood) 2004;23:9-25.
ABSTRACT | FULL TEXT  

Juvenile infection and male display: testing the bright male hypothesis across individual life histories
Borgia et al.
Behav Ecol 2004;15:722-728.
ABSTRACT | FULL TEXT  

Actual Causes of Death in the United States, 2000
Mokdad et al.
JAMA 2004;291:1238-1245.
ABSTRACT | FULL TEXT  

A population-dynamic model for evaluating the potential spread of drug-resistant influenza virus infections during community-based use of antivirals
Ferguson et al.
J Antimicrob Chemother 2003;51:977-990.
ABSTRACT | FULL TEXT  

Exposure to Pets in Childhood and Risk of Atopic Disorders
Platts-Mills et al.
JAMA 2003;289:842-843.
FULL TEXT  

Infectious Disease Hospitalizations Among American Indian and Alaska Native Infants
Holman et al.
Pediatrics 2003;111:e176-182.
ABSTRACT | FULL TEXT  

Hepatitis A Virus Infections in the United States: Model-Based Estimates and Implications for Childhood Immunization
Armstrong and Bell
Pediatrics 2002;109:839-845.
ABSTRACT | FULL TEXT  

Leptin-Deficient Mice Exhibit Impaired Host Defense in Gram-Negative Pneumonia
Mancuso et al.
J. Immunol. 2002;168:4018-4024.
ABSTRACT | FULL TEXT  

Rapid Identification of Dimorphic and Yeast-Like Fungal Pathogens Using Specific DNA Probes
Lindsley et al.
J. Clin. Microbiol. 2001;39:3505-3511.
ABSTRACT | FULL TEXT  

The Increase in Asthma Cannot Be Ascribed to Cleanliness
Platts-Mills et al.
Am. J. Respir. Crit. Care Med. 2001;164:1107-1108.
FULL TEXT  

Concepts of Time in Clinical Research
Samet
ANN INTERN MED 2000;132:37-44.
ABSTRACT | FULL TEXT  

Emerging Infectious Diseases: Public Health Issues for the 21st Century
Binder et al.
Science 1999;284:1311-1313.
ABSTRACT | FULL TEXT