1998 North Carolina vital statistics, vol 2

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North Carolina
North Carolina state center for health statistics
Leading Causes of Death
Expanded Edition
Including 1979-1998 Mortality Trends
Vital Statistics
Volume 2 - 1998
Publications of the
State Center for Health Statistics
Many of these publications are available online at http://www.schs.state.nc.us/SCHS/
North Carolina Health Statistics Pocket Guide (Biennial):
Data for the U.S., N.C., and N.C. counties are presented in tabular and narrative forms with more than 8,000 calculations
depicting patterns of various needs indicators, as well as births, deaths, abortions, diseases, health care resources, and
other data from state and national reporting systems and surveys. This composite of information, contained in a compact
foldout, will serve the needs of many health data users.
North Carolina Vital Statistics, Volume 1: Population, Births, Deaths, Marriages, Divorces (Annual):
For the state and each Perinatal Care Region (PCR), county, and major incorporated city, one-page tables summarize
annual and 5-year data by race and selected variables. Maps, graphs, and narrative describe geographical patterns and
statewide trends.
North Carolina Vital Statistics, Volume 2: Leading Causes ofDeath (Annual):
For the state and counties, cause-specific annual and 5-year data are given in the form of numbers of deaths, unadjusted
death rates, and age-adjusted death rates. For each cause, maps depict 5-year adjusted and unadjusted county rates.
Infant mortality data are also tabulated and mapped.
Basic Automated Birth Yearbook, North Carolina Residents (Annual):
Known as the BABY BOOK, this statewide report is comprised of multiple cross-tabulations of various maternal and infant
variables such as age, race, birth order, birth weight, and number of prenatal visits as well as medical conditions of the
mother, the labor/delivery, and the newborn. Data for North Carolina counties are available on microfiche.
Detailed Mortality Statistics, North Carolina Residents (Annual):
This statewide report provides annual counts of deaths specific for detailed underlying cause of death (4 digits) and age-race-
sex group. Data for counties are available on microfiche.
North Carolina Reported Pregnancies (Annual):
For the state, PCRs, and counties, annual estimates of pregnancy rates, live birth rates, abortion rates, and abortion
fractions by age and race are followed by one-page tables displaying counts of pregnancies (abortions, live births, and
fetal deaths) by race and age for total and unmarried women. Maps, graphs, and narrative describe geographical
patterns and statewide trends.
Cancer Incidence in North Carolina, County-Specific Numbers (Annual):
Observed and expected numbers of newly diagnosed cancer cases for 26 cancer sites and total cancer are provided
by county and gender. State and county tabulations of cases by race-sex and age are also provided.
North Carolina Cancer Facts and Figures (Biennial):
This collaborative report with the American Cancer Society is prepared specifically for use by the public. It contains
tabular, graphic, and narrative materials regarding cancer in North Carolina. Information about cancer control activities
and agencies in the state is also given.
Local Health Department Facility and Staffing Report (Biennial)
:
Facility-level data are compiled from health department surveys. Capacity of facilities, staffing levels, and expenditure
data are provided.
SCHS Studies (Intermittent):
Studies on health topics of current interest are presented in newsletter form.
Statistical Brief (Intermittent):
These shorter reports on health topics are designed to provide quick information for health decision makers.
Statistical Primer (Intermittent):
Short tutorials on statistical methods are presented in newsletter form.
An Inventory ofNorth Carolina Health Data (Intermittent):
This publication describes by subject-matter health data sets existing in public and nonpublic agencies. Included in the
description are the data set's location, the data collection interval, the smallest unit of analysis, whether computerized,
and the name of a contact person.
North Carolina
Leading Causes of Death
Expanded Edition
Including 1979-1998 Mortality Trends
Vital Statistics
Volume 2 -1998 SSI
DEC 4 2000
WAW L1WARY OF WORTH CA«ft*A
RALEiGH
North Carolina Public Health
Everywhere EveryDay EveryBody
North Carolina Department of Health and Human Services
Division of Public Health
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699-1908
(919) 733-4728
www.schs.state.nc.us/SCHS/
State of North Carolina
Department of Health and Human Services
Division of Public Health
Ann Wolfe, M.D., M.P.H., Director
State Center for Health Statistics
John M. Booker, Ph.D., Director
Contributing Editors:
Kathleen Jones-Vessey
Paul Buescher
Ziya Gizlice
Dianne Enright
Jean Stafford
Other Contributors:
Bob Allis
Michelle Beck-Warden
Roy Clark
Sidney Evans
Harry Herrick
Stephanie Horton
Eleanor Howell
David Liles
Bob Meyer
Majoo Mittal
Leah Randolph
Fatma Simsek
Nan Staggers
Gabrielle Principe
Maxine Terry
Tim Whitmire
Andre Williams
Bradford Woodard
March 2000
The NC Department of Health and Human Services does not discriminate on the basis of race,
color, national origin, sex, religion, age or disability in employment or the provision of services.
1,500 copies of this public document were printed at a total cost of $21,307 or $14.20 per copy.
TABLE OF CONTENTS
Page
Introduction 1
Organization of this Publication 2
Overview of Mortality in North Carolina 3
Premature Mortality in North Carolina 11
Racial and Ethnic Differences in Mortality 13
NORTH CAROLINA'S LEADING CAUSES OF DEATH 17
STATE AND COUNTY MORTALITY TABLES AND FIGURES
Mortality Statistics Summary for 1998 27
Sex-Specific Mortality Statistics Summary for 1998 27
Total Deaths - All Causes 29
Heart Disease 35
Cerebrovascular Disease 41
Cancer 47
Cancer of Colon, Rectum, and Anus 53
Cancer of Trachea, Bronchus, and Lung 59
Cancer of Female Breast 65
Cancer of Prostate 71
Acquired Immune Deficiency Syndrome 77
Septicemia 83
Diabetes Mellitus 89
Pneumonia and Influenza 95
Chronic Obstructive Pulmonary Disease 101
Chronic Liver Disease and Cirrhosis 107
Nephritis, Nephrosis, and Nephrotic Syndrome 113
Unintentional Motor Vehicle Injuries 119
Other Unintentional Injuries 125
Suicide 129
Homicide 135
Infant Mortality 141
TECHNICAL NOTES
Computation of Death Rates 149
Interpretation of Death Rates 151
Caution About Use of Rates 151
APPENDIX A - List of Selected Causes of Death 155
APPENDIX B - List of 43 Selected Causes of Death 156
APPENDIX C - List of 27 Selected Causes of Infant Death 157
APPENDIX D - Statistical Primer: Age-Adjusted Death Rates 158
in
Digitized by the Internet Archive
in 2012 with funding from
LYRASIS Members and Sloan Foundation
http://archive.org/details/northcarolinavit1998nort
Introduction
This publication shows death rates for the twenty years of mortality data (1979-1998) coded under
the International Classification of Diseases, 9th Revision (ICD-9). Beginning in 1999 causes of death
have been coded using the 10th Revision of the ICD. The State Center for Health Statistics pro-duces
a major publication annually, describing in tabular and map form North Carolina's mortality
experience over the most recent five-year period. Periodically, an expanded volume is produced
that includes a narrative analysis for each cause of death. The expanded format is resumed in this
1998 edition, which includes statistical tables, maps, and graphs, as well as discussions of cause-specific
trends, geographic patterns, risk factors, and pertinent research. An overview of mortality
in North Carolina is also presented.
The tables in this report provide selected mortality statistics for counties and the state. More than
a dozen of the leading causes of mortality in North Carolina are tabulated; in addition, four major
cancer sites and total infant mortality are included.
Four five-year death rates are presented here for the state and each county: 1979-83, 1984-88,
1989-93, and 1994-98. In keeping with the new convention of the National Center for Health
Statistics, all age-adjusted death rates use the projected year 2000 population for the United
States as the standard population. As a result, the adjusted rates in this volume will not be compa-rable
to those published in previous editions of Leading Causes of Death. A Technical Notes section
defines death rates and the methods for age adjustment of death rates. The reader is urged to
consult this section prior to using the data in this volume. Also, please refer to the Appendix for a
more detailed discussion of age-adjusted death rates.
A more exhaustive breakdown of cause-specific mortality by age, race, and sex is described in the
companion volume, North Carolina Detailed Mortality Statistics. This and other publications (listed
and described on the inside front cover of this publication) are available through the State Center for
Health Statistics. If you would like copies of these publications you may contact the Center's Informa-tion
Services Unit. Many of them are also available online at http://www.schs.state.nc.us/SCHS/.
If there are any questions concerning this publication, please contact:
State Center for Health Statistics
Division of Public Health
North Carolina Department of Health and Human Services
1908 Mail Service Center
Raleigh, NC 27699-1908
(919) 715-4490
Organization of this Publication
The first sections of this edition of Leading Causes of Death present an overview of mortality in
North Carolina and discussions of premature mortality and racial/ethnic differences in mortality.
The next sections consist of tabular data, maps, and narrative material which describe North
Carolina's recent experience with respect to total mortality and cause-specific mortality. For each
cause, risk factors, geographic patterns, differences by race and sex, and trends over time are
considered.
A Technical Notes section provides information concerning the calculation, interpretation, and
appropriate use of adjusted and unadjusted rates. Readers are cautioned about using rates based
on a small number of deaths. Any death rate with a small number of deaths in the numerator will
have substantial random variation over time. A good rule of thumb is that any rate based on fewer
than 20 events in the numerator may be subject to serious random error. Many of the death rates
in this report have numerators smaller than 20, and so extreme caution should be taken when
making comparisons or assessing trends.
Appendix A describes the selected cause-of-death categories in terms of codes from the ninth
revision of the International Classification of Diseases. Altogether, the major causes selected for
examination in this report accounted for 82 percent of all North Carolina deaths during 1998. Data
for some of the specific cancer sites listed in Appendix A are not presented at the county-level in
this report, due primarily to the relatively small numbers of deaths.
Description of Tables
Except for infant deaths, a table for each cause-of-death category includes the following items of
information for the state and each county of residence:
1. The number of resident deaths occurring during 1998;
2. The 1998 death rate;
3. The number of resident deaths occurring during 1994-98;
4. The 1994-98 average annual death rate;
5. The 1979-83, 1984-88, 1989-93, and 1994-98 average annual age-adjusted death rates
computed by the direct method, using the projected United States 2000 population as
the standard for adjustment.
The formulas for calculating single- and five-year rates are described in the Technical Notes sec-tion.
In this report, total mortality rates (all causes combined) are expressed as deaths per 1,000
population. Cause-specific rates are expressed as deaths per 100,000 population. The infant death
rates of Table 21 are computed as the number of infant deaths per 1,000 live births.
Description of Maps
This publication contains 19 sets of maps which depict data for the state's 100 counties. (See
inside of back cover for a map with county names.) For total mortality and each cause of death,
the 1994-98 unadjusted death rates and the 1994-98 age-adjusted death rates are mapped. These
maps show five levels of death rates. The interval values (levels) indicated by the map legends are
not necessarily continuous, but reflect the actual range of values for each interval. These maps
must be viewed with caution for causes where the number of deaths per county is small, since in
these cases rates can be unstable. A clustering routine from the Statistical Analysis System (SAS)
was used to group counties that are "most like each other" with respect to their unadjusted and
adjusted rates. This procedure may result in very large or very small groups, depending upon how
county rates differ from one another.
Overview of Mortality in North Carolina
Total mortality in North Carolina has exhibited an overall downward trend in this century, but an
upward trend since 1982, rising from a low of 8.1 deaths per 1,000 population in 1982 to a high of
9.0 in 1998. Probably the major factor contributing to this increase is aging of the state's popula-tion.
Other factors that affect mortality include changes in lifestyle (e.g., reduction in smoking),
environment, and the medical care system. This overview summarizes four general determinants of
mortality as well as some of the risk factors that are associated with a number of different causes.
Then premature mortality in North Carolina is examined via the concept of "years of life lost,"
which emphasizes the impact of mortality in the younger age groups.
Determinants of Mortality
A broad view of mortality determinants shows that problems "arise from causes embedded in the
social fabric of the nation as a whole"1
, and that medical care is only one aspect of health mainte-nance.
Accordingly, environment, lifestyle, biology and genetics, and medical care must all be
considered as determinants of health.
Over the past decades, environmental factors, both natural and man-made, have been increasingly
recognized as having a significant impact on health. For example, naturally occurring variations
such as water mineral content and elevation have been cited as influencing the incidence of cardio-vascular
disease2
. Another problem may be the natural occurrence of radon gas in some homes.
However, most serious environmental problems are consequences of man-made pollution of air
34
,
water, and food sources. Recent examples include atmospheric pollution from lead and ozone,
ground water contamination from toxic wastes, and occupational exposures to hazardous sub-stances.
Children are especially at risk from pollutants such as ozone56 and lead. 7,8
While pollution is a by-product of a high-technology, growth-oriented society, some favorable
consequences of economic growth include jobs, income, health insurance, and improved access to
medical care. Unemployment and poverty are generally associated with less adequate mental and
physical health. The poor, having fewer economic and social resources, experience higher levels of
stress and are more vulnerable to infectious agents, economic problems, and hazards in the home
and workplace. Rural populations are less likely to have medical insurance and good access to
medical care. In short, economic conditions and environmental factors may interact in complex
ways to affect health status.
Lifestyle refers to behaviors that affect health and over which individuals have varying degrees of
control. There are substantial data showing that certain health habits (e.g., never having smoked,
moderate or no alcohol consumption, regular exercise, sleeping 7-8 hours per night, and maintain-ing
appropriate weight) are associated with improved health and reduced mortality. 910 Individuals'
lifestyle decisions are associated with their socioeconomic status, race, and sex. Men are more
likely than women to smoke and drink excessively; younger women are more likely to smoke than
older women; blacks are more likely to be sedentary than whites; and black women are substan-tially
overweight almost twice as often as white women. Persons with fewer than 12 years of
education are more likely to smoke, not exercise, and be substantially overweight. 9 Individuals'
lifestyle decisions are significantly influenced by their demographic characteristics and socioeco-nomic
status. "Blaming the victim" by keeping the problem only at the individual level may obscure
some of the origins of disease in the socioeconomic environment. Policies to educate individuals
about their health behaviors are less complex and easier to sell politically than those aimed at
modifying the underlying social and economic determinants of lifestyle and health.
Health education of individuals is an important component in improving health. Certain population
groups are more likely to have lifestyles associated with increased mortality, and education pro-grams
are effective complements to policies oriented toward the environmental factors that condi-tion
lifestyle. For example, nutrition education can have a substantial health payoff among the
poor, but the payoff will be much higher if they have sufficient money to buy proper foods and
facilities for preparation. Sex education for prevention of sexually transmitted diseases and un-wanted
pregnancies is another area where education may be very effective in altering specific
high-risk behaviors. Income, education, and urban/rural residence are important indicators and
determinants of lifestyle, 11 and effective education programs must consider these factors. Targeting
specific high-risk groups is likely to be more successful than generalized education or media cam-paigns.
Biological factors are powerful determinants of mortality. The age, race, and sex of an individual
are biologically determined, and mortality rates vary consistently along these dimensions. For
example, health is strongly tied to aging and the life cycle. Some diseases that vary by race are
thought to be genetically linked. Biological factors in part account for the higher rate of some
diseases in men as compared to women, with women living longer on the average. However, there
are health consequences of age, race, and sex that are not biological in origin. Social stratification
is partly based on these variables, with the elderly, minorities, and females generally being ac-corded
lower socioeconomic status in the United States. Some of the elevated male mortality may
result from the aggressive, achievement-oriented lifestyle that accompanies higher status posi-tions,
12 while higher mortality among persons of racial and ethnic minorities is due in part to a
lower position in the economic hierarchy. 13
A number of diseases are directly or indirectly genetic in origin. In North Carolina, many people are
afflicted with serious genetic disorders, resulting in physical defects, mental retardation, and other
health problems, and a significant percentage of birth defects are genetic in origin. 14
It has been
estimated that 12 percent of pediatric hospitalizations are related to birth defects and genetic
diseases, 15 and about 50 percent of all childhood blindness is linked to genetic factors. 16 In North
Carolina, congenital malformations are a leading cause of mortality among infants under one year,
and second only to injuries among children ages one through four. Overall, the 1998 congenital
anomalies death rate was 5.1 deaths per 100,000 population. This is only a slight decline from a
rate of 5.3 in 1988. In addition, some persons have a genetic susceptibility to certain diseases.
Many types of cancer, for example, have genetic origins. 17
The medical care system is another important determinant of mortality levels. It responds to health
problems by attempting to restore the individual to a full and productive life. Disease prevention is
also within the purview of the medical care system, as exemplified by vaccination to prevent
infectious diseases and by patient education concerning health consequences of certain behaviors.
Medical care personnel may also be involved in addressing certain environmental causes of dis-ease,
though this type of activity has traditionally been carried out by the public health sector.
McKeown and Brown 18 present evidence suggesting that medical practice in the first half of the
19th century had little to do with the large decline in mortality that took place in Western societies.
They suggest that transportation improvements, changes in the economic system that assured a
more continuous and nutritious food supply, and improved sanitation practices in the cities were
responsible. After the practice of antisepsis became widespread late in the 19th century, medical
care became a much more positive factor in reducing mortality. During the first half of this century,
the health and average life span of Americans improved considerably, due substantially to efforts in
the medical sector to reduce infections and acute nutritional diseases. Major gains were also
observed in infant and maternal mortality, probably due to improvements in nutrition, sanitation,
and the development of vaccines. 19
Medical care may sometimes have negative health consequences. It has been estimated that
infections acquired inside the hospital strike five percent of Americans hospitalized each year,
adding to hospital costs and increasing lengths of stay. 20 - 2122 Inappropriate or unnecessary treat-ment
may increase mortality as well as health care costs. Risks are always present, even in proper
medical treatment, but in most cases they are far outweighed by the potential benefits.
In summary, a complete program to improve health status and reduce mortality must include
environmental, lifestyle, biological, and medical care strategies. Too much emphasis in one area
may involve substantial opportunity costs due to neglect of other areas. For example, expenditures
for basic research, for environmental protection, to improve substandard housing, or for public
education regarding specific risk behaviors could have higher long-term health payoffs than would
the same amount expended just for medical care. The status of heart disease and cancer as major
killers is closely linked to lifestyle and environmental factors. Sedentary occupations and consump-tion
of foods high in animal fats contribute to both heart disease and cancer. Increased economic
production and consumption have led to more exposure of the population to carcinogens in air,
water, and food. Effective cancer control will require fundamental changes in the environment as
well as modification of behaviors and lifestyle. In short, strategies to reduce cancer, heart disease,
and other leading causes of mortality must deal with factors in the fabric of contemporary society.
Risk Factors
Risk factors particular to each cause of death are discussed in separate sections of this volume.
Information about several factors that are common to a number of different causes of death is
summarized here.
Two of the most pervasive factors contributing to mortality from various diseases are high blood
pressure and cigarette smoking. Elevated blood pressure is associated with death from all cardio-vascular
diseases, diabetes mellitus, cirrhosis of the liver,
2324 and renal failure. 25 While most causes
of hypertension are amenable to treatment, many people either are unaware of having the condi-tion
or do not modify behaviors to control it (e.g., maintain proper weight, diet, and medication
regimen).
Use of tobacco products contributes to death from a large number of causes. 23 - 24' 26~29' 30 According to
data compiled by the U.S. Surgeon General, 29 cigarette smoking is a major cause of lung cancer as
well as cancers of the larynx, oral cavity, and esophagus; it is a contributory factor in the develop-ment
of cancers of the bladder, pancreas, and kidney; and approximately 30 percent of all cancer
deaths are attributable to cigarette smoking. There is evidence that it is a contributor in the devel-opment
of chronic bronchitis and emphysema, pulmonary heart disease, myocardial infarction,
aortic aneurysm, and a wide variety of other vascular diseases. In addition, smoking seems to
interact with other risk factors, such as asbestos, ionizing radiation, oral contraceptives, and certain
dietary factors, to produce a variety of cancers and vascular diseases. Use of smokeless tobacco
(snuff, chewing tobacco, and similar products) is associated with tongue cancer and oral cancers in
general. 3132 There is also substantial evidence that environmental tobacco smoke (passive smok-ing)
is associated with increased mortality. 33
Diet has an important impact on certain causes of mortality. Overeating may lead to obesity, which
is associated with high blood pressure, diabetes, cardiovascular disease, and overall mortality. 34' 35' 36
In turn, diabetes is a risk factor for stroke and other cardiovascular diseases. In addition, the
content of the modern diet has important consequences for mortality. The contemporary diet "...is
higher in intake of energy, of protein (especially animal protein), and of fat (especially animal fat),
but lower in intake of fiber-containing cereal foods; this diet is associated with high rates of mor-bidity
and mortality from degenerative diseases". 37 Decreased intake of animal fat and protein,
cholesterol, salt, sugar, and alcohol are often recommended. In addition, inadequate nutrition,
irrespective of obesity, is associated with a higher risk of certain diseases. 3839
Excessive alcohol consumption is a very large health problem in America40 and is associated with a
high risk of premature death from a variety of diseases. 4143 "While the lifestyle typical of many
heavy drinkers contributes to this risk, the effects of alcohol per se account for a substantial part
of the excess mortality". 41 In two Chicago studies, heavy drinkers had higher mortality from all
causes, cardiovascular diseases, coronary heart disease, and sudden death than could be entirely
explained by other risk factors such as blood pressure, smoking, and weight. 42 Heavy alcohol use
by pregnant women leads to birth anomalies, including fetal alcohol syndrome and subsequent
mental retardation. 40-44 Alcohol consumption increases the risk of mortality from homicide, suicide,
and unintentional injury. 43
Socioeconomic status has a very strong impact on mortality. 13 '274547 "Social class gradients of
mortality and life expectancy have been observed for centuries, and a vast body of evidence has
shown consistently that those in the lower classes have higher mortality, morbidity, and disability
rates". 13 Differences between white and minority mortality rates can be attributed largely to the
lower average socioeconomic status of minorities. Minorities are more likely to live in substandard
housing and other hazardous conditions, resulting in an array of disease consequences. Low
education contributes to poor health practices, and low income affects many aspects of health,
including nutrition. Higher stress levels and ineffective responses to stress also contribute to higher
mortality among the poor. 13
Persons of lower socioeconomic status generally receive less adequate medical care, though this
probably does not account for a major portion of the socioeconomic differences in morbidity and
mortality. 13 In fact, the association between excess mortality and low socioeconomic status persists
independent of individual behaviors or attributes such as smoking, alcohol consumption, body
mass index, physical activity, martial status, race, and sex. 48 Properties of the socioeconomic
environment are important contributors to the excess mortality. 49
Social isolation is associated with an increased risk of mortality. Persons with strong social support
and social networks have lower mortality risk, independent of other risk factors. 5053 Married per-sons
have a significantly lower risk of mortality than those who are divorced, single, separated, or
widowed, though this relationship may be due to factors besides protective effects of marriage
itself.
54 - 55
5e;r is another important variable associated with mortality. Females have lower mortality rates and
greater life expectancies than males in all developed countries. 56 The differential in death rates is
present at conception and continues for every age group. At birth, the ratio of males to females is
104:100, but by age 70 females outnumber males by approximately 3:2.
A substantial amount of excess male mortality is related to sex differences in behavior, such as
cigarette smoking, drinking alcohol, aggressive competitiveness, and occupational exposure to
environmental and physical hazards. 12 For 15-44 year-olds, more than 90 percent of the excess
male mortality may be attributable to violence and smoking. 56 Biological factors also contribute to
higher male mortality. "Thus, even among nonsmokers, men have higher mortality than women for
certain types of cancer, and this implies that there must be other factors, in addition to smoking,
that contribute to higher cancer among men". 56
To the extent that the sex difference in mortality is not due to biological factors, substantial reduc-tions
in male excess mortality may be possible through lifestyle and behavioral changes. With the
transition earlier in this century from infectious to degenerative diseases as the major causes of
death, lifestyle became more important in affecting mortality experience, and the difference be-tween
male and female mortality rates increased steadily. More recently, female mortality relative
to male mortality has actually worsened for several age groups and for several leading causes. 57
This may be associated with increased smoking26 and the adoption of other "male" behaviors by
women as job participation and mobility increase and traditional roles are modified. Thus, social
and lifestyle changes may also help to reduce female mortality.
A number of risk factors have been reviewed that bear on many causes of death, and efforts to
reduce mortality must involve consideration of these important precursors.
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29. U.S. Department of Health and Human Services, Office on Smoking and Health. The health
consequences of smoking: cancer. A report of the Surgeon General. Rockville, Maryland, 1982.
30. Prescott E, Osier M, Andersen PK, Hein HO, Borch-Johnsen K, Lange P, Schnohr P, Vestbo J.
Mortality in women and men related to smoking. International Journal of Epidemiology 1998;
27:27-32.
31. Davis S, Severson RK. Increasing incidence of cancer of the tongue in the United States among
young adults (letter). Lancet 1987; 2 (8564):910-911.
32. Connoly GN, Blum A, Richards JW. Smoke screen around oral snuff (letter). Lancet 1987; 2
(8551):160.
33. DiFranza JR, Lew RA. Morbidity and mortality in children associated with the use of tobacco
products by other people. Pediatrics 1996; 97:560-568.
8
34. Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey-Smity G. Childhood obesity and adult
cardiovascular mortality: a 57-year follow-up study based on the Boyd Orr cohort. American
Journal of Clinical Nutrition 1998; 67:1111-1118.
35. Dietz WH. Childhood weight affects adult morbidity and mortality. Journal of Nutrition 1998;
128:411S-414S.
36. Stevens J, Plankey MW, Williamson DG, Thun MJ, Rust PF, Palesch Y, O'Neil PM. The body mass
index-mortality relationship in white and African American women. Obesity Research 1998;
6:268-277.
37. Walker AR. Dietary goals, sensible eating, and nutrition in the future. South African Medical
Journalism, 57:471-511.
38. Darnton-Hill I, Coyne ET. Feast and famine: socioeconomic disparities in global nutrition and
health. Public Health Nutrition 1998; 1:23-31.
39. Wray JD. Child health interventions in urban slums: are we neglecting the importance of nutri-tion?
Health Policy and Planning 1986; 1:299-308.
40. West U, Maxwell DS, Noble EP, Solomon DH. Alcoholism. Annals of Internal Medicine 1984;
100:405-416.
41. Schmidt W, Popham RE. Heavy alcohol consumption and physician health problems: a review of
epidemiological evidence. Drug and Alcohol Dependence 1975; 1:27-50.
42. Dyer AR, et al. Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago
epidemiologic studies. Circulation 1977; 56:1067-1074.
43. Buescher PA, Patetta MJ. Alcohol-related morbidity and mortality in North Carolina. SCHS
Studies, No. 41, July 1986. North Carolina Department of Human Resources, Division of Health
Services, State Center for Health Statistics.
44. Abel EL. Prevention of alcohol abuse-related birth defects. Alcohol and Alcoholism 1998;
33:411-416.
45. Egbuonu L Child health and social status, Pediatrics 1982; 69:550-557.
46. Rosengren A, Orth-Gomer K, Wilhelmsen L. Socioeconomic differences in health indices, social
networks and mortality among Swedish men: a study of men born in 1933. Scandanavian
Journal of Social Medicine 1998; 26:272-280.
47. Casper ML, Barnett EB, Armstrong DL, Giles WH, Blanton CJ. Social class and race disparities in
premature stroke mortality among men in North Carolina. Annals of Epidemiology 1997; 7:146-
153.
48. Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors,
health behaviors, and mortality: results from a nationally representative prospective study of
US adults. Journal of the American Medical Association 1998; 279:1703-1708.
49. Haan M, Kaplan GA, Camacho T. Poverty and health: prospective evidence from the Alameda
County study. American Journal of Epidemiology 1987; 125:989-998.
50. Cerhan JR, Wallace RB. Changes in social ties and subsequent mortality in rural elders. Epide-miology
1997; 8:475-481.
51. Avlund K, Damsgaard MT, Holstein BE. Social relations and mortality: an eleven year follow-up
study of 70-year-old men and women in Denmark. Social Science and Medicine 1998; 47:635-
643.
52. Penninx BW, van Tilburg T, Kriegsman DM, Deeg DJ, Boeke AJ, van Eijk JT. Effects of social
support and personal coping resources on mortality in older age: the Longitudinal Aging Study
Amsterdam. American Journal of Epidemiology 1997; 146:510-519.
53. Kawachi I, Colditz GA, Ascherio A, Rimm EB, Giovannucci E, Stampfer MJ, Willett WC. A pro-spective
study of social networks in relation to total mortality and cardiovascular disease in
men in the USA. Journal of Epidemiology and Community Health 1996; 50:245-251.
54. Krongrad A, Lai H, Burke MA, Goodkin K, Lai S. Marriage and mortality in prostate cancer.
Journal of Urology 1996; 156:1696-1700.
55. Tucker JS, Friedman HS, Wingard DL, Schwartz JE. Marital history at midlife as a predictor of
longevity: alternative explanations to the protective effect of marriage. Health Psychology
1996; 15:94-101.
56. Waldron I. The contribution of smoking to sex differences in mortality. Public Health Reports
1986; 101(2):163-173.
57. Verbrugge LM. Recent trends in sex mortality differentials in the United States. Women and
Health 1980; 5:17-37.
10
Premature Mortality in North Carolina
Since 1914, when deaths were first centrally recorded in North Carolina, the leading causes of
mortality have usually been ranked according to number of deaths. North Carolina deaths in 1998
have been ranked in Table A based on this traditional method. As shown, heart disease and cancer
are the leading causes of death, followed by stroke (cerebrovascular disease) and unintentional
injuries.
Rankings based only on number of deaths (or rate per 100,000 population), however, do not
necessarily indicate where medical and public health intervention strategies can be most effectively
employed. Since death is postponable but not preventable, age at death is a key factor to consider.
Prevention of a death that would otherwise occur early in life could be assigned higher priority
than prevention of a death later in life. A convenient method of ranking causes of death that
incorporates age at death is by "years of life lost". 1 If the average life expectancy at birth for white
males, for example, is 72 years, a death at age 65 would mean seven years of life lost (on the
average), while a death at age 40 would mean 32 years of life lost. A white male infant death
results in 72 years of life lost, whereas deaths at ages 72 and over do not contribute to years of
life lost for white males. Based on the 1989-91 life tables for North Carolina, 2 the life expectancies
used here to calculate years of life lost were 72 for white males, 79 for white females, 65 for
minority males, and 75 for minority females. For each death in a given cause group, age at death
was subtracted from the appropriate life expectancy and all of these life-years lost were then
summed across the four race-sex groups. Deaths at ages greater than the specified life expectan-cies
were not counted.
Table B displays the leading causes of death in 1998 ranked according to years of life lost. Heart
disease and cancer are still very important causes of death from this perspective, but other causes
become much more prominent than before. Unintentional injuries (motor vehicle injuries and other
unintentional injuries) rank much higher in terms of years of life lost. Motor vehicle injury dece-dents
are on average about 28 years younger than heart disease decedents. Likewise, cancer
decedents are on average several years younger than heart disease decedents.
References
1. McDonnell S, Vossberg K, Hopkins RS, Mittan B. Using YPLL (years of potential life lost) in
health planning. Public Health Reports 1998; 113:55-61.
2. U. S. Department of Health and Human Services, National Center for Health Statistics. U.S.
decennial life tables for 1989-91, volume II, state life tables number 34, North Carolina.
Hyattsville, Maryland, May 1998.
11
TABLE A:
1998 Leading Causes of Death for North Carolina Residents
Ranked by Number of Deaths
Rank Cause of Death Number of Deaths
1 Heart Disease 19,441
2 Cancer 15,327
3 Cerebrovascular Disease 5,434
4 Chronic Obstructive Pulmonary Disease 3,200
5 Pneumonia & Influenza 2,688
6 Diabetes Mellitus 1,963
7 Motor Vehicle Injuries 1,632
8 Other Unintentional Injuries 1,586
9 Suicide 846
10 Septicemia 789
11 Nephritis, Nephrotic Syndrome & Nephrosis 702
12 Chronic Liver Disease & Cirrhosis 699
13 Homicide 664
14 AIDS 432
15 Atherosclerosis 395
Total Number of Deaths from All Causes 67,798
TABLE B:
1998 Leading Causes of Death for North Carolina Residents
Ranked by Years of Life Lost
Rank Cause of Death
Estimated
Years of Life Lost
1 Cancer 120,810
2 Heart Disease 94,058
3 Motor Vehicle Injuries 54,532
4 Other Unintentional Injuries 27,983
5 Homicide 24,324
6 Suicide 23,569
7 Cerebrovascular Disease 20,245
8 Chronic Obstructive Pulmonary Disease 14,224
9 Diabetes Mellitus 13,144
10 AIDS 12,525
11 Pneumonia & Influenza 9,637
12 Chronic Liver Disease & Cirrhosis 9,393
13 Septicemia 5,488
14 Nephritis, Nephrotic Syndrome & Nephrosis 2,310
15 Atherosclerosis 709
Total Years of Life Lost Due to All Causes 573,366
12
Racial and Ethnic Differences in Mortality
Graphs of trends in age-adjusted death rates for whites and minorities are included in each cause-of-
death section. These graphs show single-year age-adjusted death rates for the years 1979
through 1998. These graphs will help identify causes of death where there are large racial dispari-ties
in mortality and portray changes in the patterns over time. The county-level mortality data in
this publication are not broken out by race, in part for statistical reasons. Many counties have a
very small minority population and the number of deaths, even for a five-year period, would be too
small to produce reliable age-adjusted death rates for specific causes of death.
There are advantages of showing mortality data by race, to target resources and interventions toward
populations most in need. However, hazards exist in interpreting the data. Race in and of itself does not
generally cause poor health status. We do not have a complete understanding of why race is associated
with health problems, but it is likely that factors such as socioeconomic status, stress, and racism are
among the underlying causes of the higher mortality of minorities (on average) compared to whites.
Few of our health data have these types of information recorded, while most do have information on
race. Thus, race often serves as a surrogate measure for a variety of other factors. Still, there is wide
interest in North Carolina in descriptive health statistics broken out by race.
The State Center for Health Statistics normally publishes data by race for only two groups: white
and minority. We do recognize and appreciate the various population groups in North Carolina and
the need for more details on race, such as for American Indians and Asians. Several factors have
hampered efforts to obtain accurate data for specific minority populations. In addition to the issue
of small numbers leading to unreliable rates, there are other technical reasons why we usually
show data for only the two race groups. First, detailed census data on race is collected only once
every ten years. The racial structure of North Carolina's population can change dramatically over
the course of a decade. Therefore, as years pass after the latest census, it is more difficult to
extrapolate accurate population figures. Second, the State Center relies on annual population
estimates supplied by the North Carolina Office of State Planning. They produce official annual
population estimates only for "white" and "other." For this reason, the appropriate denominators to
produce rates for specific racial groups are not routinely available.
A similar problem exists when attempting to study mortality rates by Hispanicity. The Hispanic/
Latino population is an ethnic group, rather than a racial group, and Hispanics may be counted in
both white and minority racial groups in our death files. In addition, as with racial groups, there
are significant challenges in collecting accurate population data for Hispanics. Over the course of
the last decade North Carolina has experienced a dramatic increase in its Hispanic/Latino popula-tion.
However, population data for Hispanics/Latinos are based on the 1990 census and it is likely
that these are underestimates of the true population.
In an effort to address these concerns, the State Center plans to develop its own estimates of the
population of specific racial and ethnic groups. A special study is planned which will examine racial
and ethnic differences in mortality in greater detail.
In addition to the trend graphs of white and minority age-adjusted deaths rates shown in each
cause-of-death section, two tables are included here that portray state-level differences in cause-specific
mortality by race and race-sex for the period 1994-1998 (Tables C and D). These tables
show numbers of deaths and age-adjusted death rates for whites and minorities and for white
males, white females, minority males, and minority females. In North Carolina, approximately 90
percent of the minority population is African American, so the data for minorities in this publication
will closely reflect the experience of African Americans.
13
TABLE C:
Race-Sex-Specific Age-Adjusted Mortality Rates*
North Carolina Residents, 1994-98
White Males White Females Minority Males Minority Females
Causes of Death: Number Rate Number Rate Number Rate Number Rate
Total Deaths — All Causes 125,556 1119.0 123,940 708.2 41,011 1592.0 37,377 933.2
Heart Disease 38,530 352.0 37,773 210.5 10,236 433.8 10,623 271.4
Cerebrovascular Disease 7,553 75.7 12,396 68.7 2,721 120.4 3,684 94.1
Atherosclerosis 555 5.8 1,030 5.6 177 9.2 269 6.9
Cancer 31,349 262.8 27,002 158.5 9,185 382.6 7,558 192.1
Lip, Oral Cavity, & Pharynx 518 4.1 321 1.8 256 9.1 74 1.9
Stomach 615 5.3 487 2.8 301 13.0 247 6.3
Colon, Rectum, & Anus 2,850 24.4 2,941 16.9 742 31.7 985 25.2
Liver 639 5.2 416 2.4 174 6.6 109 2.8
Pancreas 1,385 11.5 1,444 8.3 452 18.6 505 13.0
Larynx 280 2.3 71 0.4 158 6.0 21 0.5
Trachea, Bronchus,
& Lung 12,016 96.1 6,668 39.0 2,935 117.7 1,168 29.9
Malignant Melanoma 579 4.7 391 2.4 11 0.4 28 0.7
Female Breast n/a n/a 4,345 26.3 n/a n/a 1,480 37.4
Cervix Uteri n/a n/a 418 2.6 n/a n/a 267 6.6
Ovary & Other Uterine
Adnexa n/a n/a 1,477 8.7 n/a n/a 302 7.7
Prostate 3,216 32.5 n/a n/a 1,766 85.7 n/a n/a
Bladder 762 7.0 364 2.0 122 5.5 98 2.5
Brain Tumors 830 6.3 763 4.7 90 2.9 110 2.7
Non-Hodgkins Lymphoma 1,210 10.0 1,218 7.0 210 7.8 177 4.4
Leukemia 1,217 10.4 937 5.5 248 9.3 231 5.7
AIDS 1,044 7.3 102 0.7 1,915 50.3 663 14.3
Septicemia 935 8.9 1,369 7.7 464 19.6 604 15.2
Diabetes Mellitus 2,663 22.8 2,935 16.8 1,269 51.2 2,089 53.5
Pneumonia & Influenza 4,472 47.9 5,571 30.8 1,208 55.1 1,058 26.8
COPD 6,922 62.4 6,018 34.1 1,204 54.7 678 17.1
Chronic Liver Disease
& Cirrhosis 1,639 12.3 892 5.4 586 19.0 312 7.7
Nephritis & Nephrosis 1,103 11.0 1,158 6.5 524 23.7 627 16.1
Unintentional Motor
Vehicle Injuries 3,568 26.3 1,918 13.1 1,452 37.5 669 14.3
All Other Unintentional
Injuries 3,471 29.1 2,216 13.1 1,305 41.2 586 13.9
Suicide 3,050 22.5 797 5.5 511 12.9 88 1.9
Homicide 1,055 7.4 401 2.8 1,605 37.5 444 9.1
Using a U.S. 2000 Population Standard. All rates are per 100,000 Population.
14
TABLE D:
Age-Adjusted Mortality Rates* by Race and Sex
North Carolina Residents, 1994-98
White Minority Male* Females Overall
Causes of Death: Number Rate Number Rate Number Rate Number Rate Number Rate
Total Deaths — All Causes 249,496 877.5 78,388 1192.8 166,567 1205.4 161,317 755.5 327,884 940.3
Heart Disease 76,303 269.8 20,859 335.3 48,766 366.1 48,396 222.5 97,162 282.0
Cerebrovascular Disease 19,949 72.0 6,405 104.9 10,274 83.1 16,080 73.6 26,354 78.0
Atherosclerosis 1,585 5.8 446 7.7 732 6.4 1,299 5.8 2,031 6.1
Cancer 58,351 198.6 16,743 261.6 40,534 282.8 34,560 165.2 75,094 210.1
Lip, Oral Cavity,
& Pharynx 839 2.9 330 4.9 774 5.0 395 1.9 * 1,169 3.3
Stomach 1,102 3.8 548 8.7 916 6.5 734 3.4 1,650 4.7
Colon, Rectum, & Anus 5,791 20.0 1,727 27.5 3,592 25.6 3,926 18.5 7,518 21.3
Liver 1,055 3.6 283 4.3 813 5.5 525 2.5 1,338 3.7
Pancreas 2,829 9.6 957 15.2 1,837 12.7 1,949 9.1 3,786 10.6
Larynx 351 1.2 179 2.7 438 2.9 92 0.4 530 1.5
Trachea, Bronchus,
& Lung 18,684 62.3 4,103 63.7 14,951 99.8 7,836 37.4 22,787 62.6
Malignant Melanoma 970 3.3 39 0.6 590 3.9 419 2.1 1,009 2.8
Female Breast 4,345 26.3 1,480 37.4 n/a n/a 5,825 28.6 5,825 28.6
Cervix Uteri 418 2.6 267 6.6 n/a n/a 685 3.4 685 3.4
Ovary & Other Uterine
Adnexa 1,477 8.7 302 7.7 n/a n/a 1,779 8.5 1,779 8.5
Prostate 3,216 32.5 1,766 85.7 4,982 41.0 n/a n/a 4,982 41.0
Bladder 1,126 3.9 220 3.6 884 6.8 462 2.1 1,346 3.9
Brain Tumors 1,593 5.4 200 2.8 920 5.7 873 4.3 1,793 4.9
Non-Hodgkins Lymphoma 2,428 8.3 387 5.8 1,420 9.7 1,395 6.6 2,815 7.9
Leukemia 2,154 7.4 479 7.1 1,465 10.3 1,168 5.6 2,633 7.4
AIDS 1,146 4.0 2,578 30.6 2,959 16.4 765 4.0 3,724 10.1
Septicemia 2,304 8.2 1,068 16.8 1,399 10.8 1,973 9.2 3,372 9.8
Diabetes Mellitus 5,598 19.3 3,358 53.1 3,932 27.6 5,024 23.6 8,956 25.3
Pneumonia & Influenza 10,043 36.6 2,266 37.0 5,680 49.2 6,629 30.2 12,309 36.8
COPD 12,940 44.2 1,882 30.1 8,126 61.3 6,696 31.1 14,822 41.9
Chronic Liver Disease
& Cirrhosis 2,531 8.6 898 12.6 2,225 13.6 1,204 5.9 3,429 9.5
Nephritis & Nephrosis 2,261 8.1 1,151 18.9 1,627 13.2 1,785 8.2 3,412 10.0
Unintentional Motor
Vehicle Injuries 5,486 19.4 2,121 24.6 5,020 28.6 2,587 13.4 7,607 20.6
All Other Unintentional
Injuries 5,687 20.4 1,891 25.4 4,776 31.5 2,802 13.4 7,578 21.5
Suicide 3,847 13.4 599 6.8 3,561 20.7 885 4.6 4,446 12.0
Homicide 1,456 5.1 2,049 22.3 2,660 14.3 845 4.4 3,505 9.3
Using a U.S. 2000 Population Standard. All rates are per 100,000 Population.
15
NORTH CAROLINA'S
LEADING CAUSES OF DEATH
Figure A: NC Resident Deaths by
Five Leading Causes, 1998
All Other Causes
31%
Unintentional
Injuries
5%
Cerebrovascular
disease
8%
Heart Disease
29%
Cancer
22%
Figure B: NC Resident Deaths by
Five Leading Causes, 1978
Pneumonia &
Influenza
3%
Unintentional
Injuries
7%
All Other Causes
25%
Cerebrovascular
disease
10%
Cancer
19%
Heart Disease
36%
19
Figure C: NC Resident Deaths by
Five Leading Causes, 1958
Pneumonia &
Influenza
4%
All Other Causes
28% Heart Disease
36%
Unintentional
Injuries
7%
Cerebrovascular
disease
12%
Cancer
13%
Figure D: NC Resident Deaths by
Five Leading Causes, 1938
All Other Causes
48%
Congenital
Malformations
7% Nephritis
9% Cerebrovascular
disease
9%
Heart Disease
17%
Pneumonia &
Influenza
10%
20
TABLE E:
Leading Causes of Death* by Age Group
North Carolina Residents, 1998
ALL AGES
Rank Cause Number
1 Heart disease 19,441
2 Cancer 15,327
3 Cerebrovascular disease 5,434
4 Chronic obstructive pulmonary disease ... 3,200
5 Pneumonia & influenza 2,688
6 Diabetes mellitus 1,963
7 Motor vehicle injuries 1,632
8 Other unintentional injuries 1,586
9 Suicide 846
10 Septicemia 789
All other causes (Residual) 14,892
Total Deaths - All Causes 67,798
INFANTS (AGE <1)
Rank Cause Number
1 Conditions originating in perinatal period ... 563
2 Congenital anomalies (birth defects) 196
3 Symptoms/signs & ill-defined conditions .... 113
4 Other diseases of the nervous system 18
5 Other unintentional injuries 15
6 Pneumonia/influenza .? 11
Septicemia 11
8 All other respiratory system diseases 10
Homicide 10
10 Motor vehicle injuries 9
All other causes (Residual) 81
Total Deaths - All Causes 1,037
1 - 4 YEARS 5 -14 YEARS
Rank Cause Number
1 Motor vehicle injuries 22
2 Congenital anomalies (birth defects) 19
3 Other unintentional injuries 16
4 Heart disease 11
5 Homicide 10
Cancer 10
7 Conditions originating in perinatal period 6
Septicemia 6
9 Pneumonia & influenza 3
Symptoms/signs & ill-defined conditions 3
All other causes (Residual) 33
Total Deaths - All Causes 139
Rank Cause Number
1 Motor vehicle injuries 68
2 Other unintentional injuries 46
3 Cancer 26
4 Heart disease 13
Suicide 13
6 Homicide 9
7 Congenital anomalies (birth defects) 8
8 Symptoms/signs & ill-defined conditions 7
9 Pneumonia & influenza 5
10 Anemias 4
Chronic obstructive pulmonary disease 4
All other causes (Residual) 52
Total Deaths - All Causes 255
'Leading causes of death are generated from a list of 43 causes of death categories developed by the National Center for Health
Statistics to promote comparability in analyses of mortality. For deaths under one year of age, a list of 27 causes of death was used.
See Appendices for the ICD-9 codes for these lists of causes.
21
TABLE E: (cont.)
Leading Causes of Death* by Age Group
North Carolina Residents, 1998
15 -24 YEARS 25 - 44 YEARS
Rank Cause Number
1 Motor vehicle injuries 385
2 Homicide & legal intervention 163
3 Other unintentional injuries 106
4 Suicide 87
5 Cancer 31
6 Heart disease 27
7 Symptoms/signs & ill-defined conditions 22
8 Congenital anomalies (birth defects) 13
9 Cerebrovascular disease 12
10 Chronic obstructive pulmonary disease 11
All other causes (Residual) 91
Total Deaths - All Causes 948
Rank Cause Number
1 Cancer 656
2 Heart disease 578
3 Motor vehicle injuries 554
4 Suicide 351
5 Homicide & legal intervention 348
6 Other unintentional injuries 341
7 HIV/AIDS 298
8 Cerebrovascular disease 127
9 Chronic liver disease/cirrhosis 95
10 Diabetes mellitus 77
All other causes (Residual) 763
Total Deaths - All Causes 4,188
45 - 64 YEARS AGES 65 & OVER
Rank Cause Number
1 Cancer 4,068
2 Heart disease 3,291
3 Cerebrovascular disease 607
4 Diabetes mellitus 482
5 Chronic obstructive pulmonary disease 428
6 Motor vehicle injuries 313
7 Chronic liver disease/cirrhosis 295
8 Other unintentional injuries 258
9 Suicide 238
10 Pneumonia & influenza 227
All other causes (Residual) 2,014
Total Deaths - All Causes 12,221
Rank Cause Number
1 Heart disease 15,498
2 Cancer 10,533
3 Cerebrovascular disease 4,678
4 Chronic obstructive pulmonary disease ... 2,727
5 Pneumonia &. influenza 2,362
6 Diabetes mellitus 1,398
7 Other unintentional injuries 804
8 Other diseases of the arteries 637
9 Nephritis, nephrotic syndrome, nephrosis ..611
Septicemia 611
All other causes (Residual) 9,151
Total Deaths - All Causes 49,010
* Leading causes of death are generated from a list of 43 causes of death categories developed by the National Center for Health
Statistics to promote comparability in analyses of mortality. For deaths under one year of age, a list of 27 causes of death was used.
See Appendices for the ICD-9 codes for these lists of causes.
22
TABLE F:
Leading Causes of Death* by Race
North Carolina Residents, 1998
WHITE BLACK
Rank Cause Number
1 Heart disease 15,284
2 Cancer 12,003
3 Cerebrovascular disease 4,138
4 Chronic obstructive pulmonary disease ... 2,802
5 Pneumonia & influenza..... 2,170
6 Diabetes mellitus 1,193
7 Motor vehicle injuries 1,196
8 Other unintentional injuries 1,233
9 Suicide 742
10 Other diseases of the arteries 599
All other causes (Residual) 10,513
Total Deaths - All Causes 51,873
Rank Cause Number
1 Heart disease 3,971
2 Cancer 3,182
3 Cerebrovascular disease 1,252
4 Diabetes mellitus 728
5 Pneumonia & influenza j, 500
6 Motor vehicle injuries 391
7 Chronic obstructive pulmonary disease 370
8 Homicide & legal intervention 364
9 HIV/AIDS 338
10 Other unintentional injuries 331
All other causes (Residual) 3,770
Total Deaths - All Causes 15,197
AMERICAN INDIAN
Rank Cause Number
1 Heart disease 159
2 Cancer 101
3 Diabetes mellitus 38
4 Cerebrovascular disease 34
5 Motor vehicle injuries 31
6 Chronic obstructive pulmonary disease 25
7 Homicide & legal intervention 22
8 Other unintentional injuries 17
9 Conditions originating in perinatal period 13
Pneumonia & influenza 13
All other causes (Residual) 106
Total Deaths - All Causes 559
* Racial group totals will not add up to overall total because deaths occurring among other races are not included here. Caution
should be taken when comparing the number of deaths across racial groupings. Population size varies considerably from one racial
group to another. The number of deaths for each group is to a large extent a reflection of that population size.
23
TABLE G:
Leading Causes of Death by Sex
North Carolina Residents, 1998
FEMALE MALE
Rank Cause Number
1 Heart disease 9,858
2 Cancer 7,069
3 Cerebrovascular disease 3,337
4 Pneumonia & influenza 1,490
5 Chronic obstructive pulmonary disease ... 1,433
6 Diabetes mellitus 1,068
7 Other unintentional injuries 590
8 Motor vehicle injuries 521
9 Septicemia 479
10 Nephritis, nephrotic syndrome, nephrosis... 370
All other causes (Residual) 7,703
Total Deaths - All Causes 33,918
Rank Cause Number
1 Heart disease 9,583
2 Cancer 8,258
3 Cerebrovascular disease 2,097
4 Chronic obstructive pulmonary disease ... 1,767
5 Pneumonia & influenza 1,198
6 Motor vehicle injuries 1,111
7 Other unintentional injuries 996
8 Diabetes mellitus 895
9 Suicide 671
10 Homicide & legal intervention 513
All other causes (Residual) 6,791
Total Deaths - All Causes 33,880
TABLE H:
Leading Causes of Death* by Hispanicity
North Carolina Residents, 1998
HISPANIC NON-HISPANIC
Rank Cause Number
1 Motor vehicle injuries 91
2 Homicide & legal intervention 43
3 Other unintentional injuries 33
4 Heart disease 24
5 Cancer 20
6 Congenital anomalies (birth defects) 16
7 Suicide 15
8 Cerebrovascular disease 9
Conditions originating in perinatal period 9
Symptoms/signs & ill-defined conditions 9
All other causes (Residual) 32
Total Deaths - All Causes 301
Rank Cause Number
1 Heart disease 19,413
2 Cancer 15,307
3 Cerebrovascular disease 5,425
4 Chronic obstructive pulmonary disease ... 3,200
5 Pneumonia & influenza 2,687
6 Diabetes mellitus 1,960
7 Motor vehicle injuries 1,552
8 Other unintentional injuries 1,540
9 Suicide 831
10 Septicemia 788
All other causes (Residual) 14,773
Total Deaths - All Causes 67,476
'Ethnicity group totals will not add up to overall total because deaths with unknown Hispanicity are not included here.
24
STATE AND
COUNTY MORTALITY
TABLES AND FIGURES
Table I:
Mortality Statistics Summary for 1998
All North Carolina Residents*
Cause of Death
Number
of Deaths
1998
Death
Rate
1998*
Total Deaths - All Causes 67,798 9.0
Heart Disease 19,441 257.6
Cerebrovascular Disease 5,434 72.0
Atherosclerosis 395 5.2
Cancer 15,327 203.1
Lip, Oral Cavity, & Pharynx 225 ' 3.0
Stomach 335 4.4
Colon, Rectum, & Anus 1,517 20.1
Liver 283 3.7
Pancreas 846 11.2
Larynx 114 1.5
Trachea, Bronchus, & Lung 4,692 62.2
Malignant Melanoma... 228 3.0
Bladder 268 3.6
Brain Tumors 346 4.6
Non-Hodgkins Lymphoma 609 8.1
Leukemia 555 7.4
AIDS 432 5.7
Septicemia 789 10.5
Diabetes Mellitus 1,963 26.0
Pneumonia & Influenza 2,688 35.6
Chronic Obstructive Pulmonary Disease (COPD) 3,200 42.4
Chronic Liver Disease & Cirrhosis 699 9.3
Nephritis & Nephrosis 702 9.3
Unintentional Motor Vehicle Injuries 1,632 21.6
All Other Unintentional Injuries & Adverse Effects 1,586 21.0
Suicide 846 11.2
Homicide 664 8.8
Table J:
Sex-Specific Mortality Statistics Summary for 1998
North Carolina Male and Female Residents*
Cause of Death
Number
of Deaths
1998
Death
Rate
1998
Cancer
Female Breast 1,163
Cervix Uteri 124
Ovary & Other Uterine Adnexa 333
Prostate 983
29.9
3.2
8.6
26.9
Note: The death rate for all causes is per 1,000 population while cause-specific death rates are per 100,000 population. The death rates
in Table J cannot be compared to those in Table I because the denominators are sex-specific. Therefore, in ranking the causes of
death-for example, in ranking the leading cancer sites-one must use the observed numbers of deaths.
* See Appendices for Cause of Death codes.
27
Total Deaths - All Causes
Introduction
During 1998 a total of 67,798 North Carolinians died. This number represents an annual death rate
of 9.0 resident deaths per 1,000 population. One confounding factor in making comparisons of
mortality rates is that age structure of a population, which has an important impact on mortality,
may vary among geographic areas and over time. It is important to adjust for age when comparing
death rates among counties within North Carolina. Also, adjustment for age affects comparisons of
North Carolina to the nation as a whole. North Carolina's unadjusted overall death rate for 1997 of
8.9 was 3 percent higher than the 1997 death rate for the United States of 8.6. { After adjustment
for age, North Carolina's 1997 death rate was 7 percent higher than that for the United 'States.
This suggests that North Carolina has a somewhat younger population than the nation as a whole.
Since death rates are much lower in the younger age groups, a younger population will tend to
reduce the unadjusted death rate.
Differentials and Trends
While the North Carolina trend for unadjusted rates indicates some increase in mortality, due to
aging of the population, examination of age-adjusted rates shows a different pattern. From 1979-
83 to 1994-98 the risk of death for North Carolinians declined by 8 percent, from 10.2 to 9.4 per
1,000 population (using the projected United States year 2000 population as the standard for
adjustment).
General comparisons or mortality can mask variations by race and sex. Looking at North Carolina
deaths in the 1994-98 period, the age-adjusted male rate (12.1) exceeded the female rate (7.6) by
59 percent. There is little difference in the 1994-98 unadjusted death rates by race: 9.0 for whites
compared to 8.9 for minorities. The minority population has a younger age distribution than whites
and this accounts for their similar unadjusted death rates. Comparing the age-adjusted death rates
for 1994-98, the rates are 11.9 for minorities and 8.8 for whites. By race and sex, the age-adjusted
death rates for 1994-98 were as follows: 11.2 for white males, 7.1 for white females, 15.9 for
minority males, and 9.3 for minority females. In the following sections, important differences in the
risk of mortality by race and sex groups are described for the major causes of death.
Risk Factors
See the section "Overview of Mortality in North Carolina" for a review of general mortality risk
factors.
Geographic Patterns
The 1994-98 unadjusted total mortality rates for counties ranged from 14.1 in Polk County to 5.6
in Wake County, with a state rate of 9.0 per 1,000 population. Figure l.C shows several scattered
groups of high-rate counties, with the northeast having the largest cluster. This general pattern
persists in eastern North Carolina after adjustment for age (Figure l.D), which indicates that
factors other than age distribution are causing the higher rates in these counties. Figure l.D shows
a large band of contiguous, high-rate counties extending from Virginia to South Carolina in the
eastern third of North Carolina.
29
References
1. Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. National Vital Statistics
Reports 1999, 47(19). Hyattsville, Maryland: National Center for Health Statistics.
30
i- =
S.+3
& iS
fO Q. * O
£ °-
re
Q
Total Deaths - All Causes:
North Carolina Resident
Age-Adjusted* Death Rates by Race 1979-1998
15
10
-A A A-
-White
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
10.0 9.8 94 95 9.3 9.4 9.4 9.2 94 9.1
12 1 12.1 12.3 12.1
9.9
-Minority 12.1 12 8 12.5 11.7 12.0 11.8 12.1
9.1 9.0
12.0 12.0
8.9
12.1
9.1
12.2
8.9
12.3
8.9
12.1 12 I
8.6
11.5
8.6
11.7
Year
"U.S. 2000 standard population
Figure 1.A
Total Deaths - All Causes:
North Carolina Resident
Age-Adjusted* Death Rates by Sex 1979-1998
c
0) o
Q.
TO
25
o.
o
a.
15
—
—
-
10
—— - —•—
—A
—
5
—A
—
—A
—
—A
-A- —A——A- A
—
—A——A
—
—A
—
—A
—
—A——A——
A
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
— —Male 14.0 14.3 13.9 13.1 13.3 13.0 D.O 13.1 12.9 13.2 12.7 12.8 12.5 12.6 12.7 12.5 12.4 12.1 11.7 11.7
—£—Female 7.8 8.0 7.9 7.6 7.7 7.6 7.8 7.8 7.7 7.8 7.6 7.5 7.6 7.6 7.6 7.6 7.6 7.6 7.5 7.5
Year
*U.S. 2000 standard population
Figure 1.B
31
TABLE 1
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Total Deaths - All Causes
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
North Carolina 67,798 9.0 327,884 9.0 10.2 9.9 9.7 9.4
1 Alamance 1,229 10.1 5,987 10.2 10.2 9.4 9.4 9.0
2 Alexander 280 8.8 1,278 8.3 9.8 9.1 9.4 9.0
3 Alleghany 129 13.1 660 13.6 9.2 9.0 8.6 9.2
4 Anson 255 10.6 1,356 11.3 10.3 10.2 10.4 10.0
5 Ashe 286 12.1 1,380 11.8 9.1 8.8 8.8 8.8
6 Avery 191 12.5 892 11.7 10.5 10.2 9.8 10.0
7 Beaufort 536 12.3 2,617 12.1 11.4 11.3 11.0 10.6
8 Bertie 262 13.1 1,315 12.9 11.7 11.5 11.4 12.1
9 Bladen 375 12.2 1,798 12.0 11.5 11.1 11.3 10.8
10 Brunswick 662 9.8 3,110 9.9 9.9 9.4 9.4 9.3
11 Buncombe 2,113 10.9 10,360 10.9 9.6 9.4 9.0 8.9
12 Burke 873 10.4 3,854 9.4 9.5 9.7 9.3 9.0
13 Cabarrus 1,081 9.0 4,991 8.8 10.2 9.5 9.0 8.9
14 Caldwell 664 8.8 3,379 9.1 9.6 9.8 9.4 9.1
15 Camden 66 10.3 322 10.2 11.2 10.2 9.7 10.0
16 Carteret 601 10.1 2,895 10.0 10.3 9.8 9.5 9.3
17 Caswell 257 11.5 1,167 10.8 10.3 9.5 9.7 9.4
18 Catawba 1,222 9.3 5,795 9.1 9.9 9.7 9.7 9.5
19 Chatham 461 10.0 2,130 9.7 9.8 9.5 8.9 8.7
20 Cherokee 290 12.7 1,342 12.1 8.4 8.3 8.2 8.8
21 Chowan 163 11.3 865 12.2 10.9 10.5 10.0 9.4
22 Clay 101 12.3 488 12.4 9.5 8.6 7.6 8.7
23 Cleveland 959 10.4 4,710 10.5 10.4 10.0 10.1 9.8
24 Columbus 599 11.5 2,891 11.2 11.4 11.0 11.3 10.7
25 Craven 817 9.2 3,730 8.6 10.9 10.0 9.8 9.8
26 Cumberland 1,826 6.2 8,958 6.1 11.2 11.6 10.7 10.0
27 Currituck 155 9.0 771 9.5 10.2 11.4 10.2 10.2
28 Dare 206 7.3 990 7.5 8.8 8.9 8.8 8.8
29 Davidson 1,170 8.3 5,987 8.7 9.4 9.4 9.2 9.0
30 Davie 335 10.4 1,492 9.8 9.3 10.3 8.6 8.9
31 Duplin 488 11.0 2,540 11.7 11.2 10.9 10.9 11.1
32 Durham 1,728 8.6 8,439 8.6 10.5 10.1 9.7 10.4
33 Edgecombe 644 11.8 3,130 11.2 11.4 11.1 11.7 11.6
34 Forsyth 2,707 9.3 12,953 9.1 10.0 9.7 9.6 9.2
35 Franklin 411 9.2 1,988 9.3 10.7 9.3 10.0 9.6
36 Gaston 1,826 10.1 8,938 10.0 10.3 10.4 10.3 10.4
37 Gates 105 10.5 563 11.4 10.0 10.8 10.7 11.1
38 Graham 77 10.3 451 12.1 8.5 9.8 9.4 9.7
39 Granville 456 10.2 2,115 10.0 11.3 10.4 10.4 10.4
40 Greene 160 8.7 783 9.1 10.8 10.0 9.1 9.0
41 Guilford 3,272 8.4 16,514 8.8 10.0 9.7 9.6 9.1
42 Halifax 650 11.7 3,351 11.9 11.8 10.7 11.2 11.2
43 Harnett 745 8.9 3,525 8.9 11.5 11.1 10.0 9.8
44 Haywood 584 11.3 2,893 11.5 9.3 9.3 8.6 8.0
45 Henderson 1,032 12.8 5,001 12.9 8.7 8.3 8.4 8.3
46 Hertford 273 12.7 1,340 12.1 10.2 10.7 11.1 10.9
47 Hoke 212 7.1 1,024 7.3 10.1 9.2 10.9 9.3
48 Hyde 60 10.5 335 12.6 10.7 10.7 11.1 10.3
49 Iredell 1,049 9.2 5,047 9.5 10.0 9.6 9.4 9.3
50 Jackson 296 10.0 1,376 9.5 9.0 9.0 8.7 8.5
K Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
Note: Death rates in this table are per 1,000 population while cause-specific death rates are per 100,000 population.
32
TABLE 1 (cont.)
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Total Deaths - All Causes
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
51 Johnston 977 9.1 4,545 9.1 11.5 10.5 10.1 9.7
52 Jones 121 13.1 573 12.3 10.1 10.0 9.6 11.6
53 Lee 472 9.7 2,212 9.4 11.6 10.3 10.1 9.4
54 Lenoir 686 11.7 3,359 11.4 11.9 11.1 11.1 10.8
55 Lincoln 499 8.4 2,413 8.5 10.0 9.6 9.4 9.2
56 McDowell 416 10.4 1,932 10.1 9.2 9.8 9.4 8.8
57 Macon 349 12.4 1,741 12.9 8.8 8.5 7.8 8.0
58 Madison 205 10.9 996 11.0 9.6 9.7 9.6 8.6
59 Martin 293 11.4 1,433 11.1 10.9 11.2 10.8 10.2
60 Mecklenburg 4,251 6.8 20,846 7.0 10.0 9.5 9.5 9.2
61 Mitchell 182 12.4 946 12.9 10.2 9.5 9.2 9.3
62 Montgomery 248 10.0 1,161 9.6 10.7 9.7 9.8 9.7
63 Moore 859 12.1 3,928 11.6 10.4 9.9 8.5 8.1
64 Nash 820 9.3 4,007 9.4 11.7 10.9 10.8 9.9
65 New Hanover 1,258 8.5 6,117 8.6 10.6 10.4 9.5 8.8
66 Northampton 246 11.9 1,320 12.7 12.0 11.4 10.7 10.5
67 Onslow 739 5.0 3,438 4.6 10.3 9.7 9.6 10.1
68 Orange 651 6.0 3,065 5.7 9.5 8.8 8.4 8.0
69 Pamlico 162 13.4 707 11.8 10.2 9.4 9.5 9.2
70 Pasquotank 325 9.3 1,718 10.1 10.6 10.0 10.1 9.7
71 Pender 343 9.0 1,699 9.5 10.4 9.9 9.6 9.1
72 Perquimans 135 12.3 680 12.6 9.2 9.5 9.3 9.7
73 Person 324 9.7 1,706 10.5 10.2 9.5 9.4 9.6
74 Pitt 1,004 7.9 4,923 8.2 11.3 11.1 10.7 10.5
75 Polk 249 14.9 1,137 14.1 9.4 8.7 8.8 8.1
76 Randolph 989 8.0 4,863 8.2 9.5 9.2 9.1 8.5
77 Richmond 490 10.8 2,598 11.4 11.1 10.5 10.9 10.9
78 Robeson 1,128 9.9 5,472 9.8 11.5 11.3 11.3 11.5
79 Rockingham 1,004 11.2 4,838 10.9 10.6 10.4 9.9 9.8
80 Rowan 1,379 11.1 6,518 10.8 9.6 9.4 9.5 9.5
81 Rutherford 698 11.6 3,435 11.6 10.0 9.6 9.6 9.9
82 Sampson 629 11.8 2,935 11.4 10.9 10.7 10.5 10.5
83 Scotland 365 10.4 1,753 10.0 11.6 12.0 11.5 11.4
84 Stanly 629 11.3 2,921 10.7 10.0 9.6 9.2 9.8
85 Stokes 380 8.8 1,811 8.6 9.7 9.6 9.4 9.2
86 Surry 747 11.0 3,602 10.9 9.8 9.5 9.0 9.4
87 Swain 140 11.5 714 12.1 10.8 11.4 11.2 10.3
88 Transylvania 324 11.4 1,550 11.2 8.3 8.2 7.8 7.9
89 Tyrrell 50 12.8 225 11.9 11.5 11.3 10.2 9.4
90 Union 803 7.3 3,731 7.3 9.4 9.3 9.7 9.6
91 Vance 486 11.7 2,356 11.6 11.5 11.0 11.7 11.9
92 Wake 3,223 5.6 15,016 5.6 9.8 9.3 8.6 8.5
93 Warren 240 12.7 1,087 11.9 11.2 11.4 10.0 9.2
94 Washington 158 12.1 777 11.5 11.9 11.3 10.4 10.6
95 Watauga 290 7.1 1,342 6.7 8.2 8.0 7.2 7.7
96 Wayne 1,012 8.9 4,857 8.7 11.3 11.6 10.9 10.4
97 Wilkes 644 10.2 2,889 9.2 9.9 9.8 9.4 8.7
98 Wilson 747 10.8 3,759 11.0 11.9 11.4 11.5 11.2
99 Yadkin 334 9.4 1,612 9.4 9.0 9.6 9.3 8.2
100 Yancey 156 9.4 805 9.9 8.3 8.0 8.3 7.4
*Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
Note: Death rates in this table are per 1,000 population while cause-specific death rates are per 100,000 population.
33
Total Deaths - All Causes
Mortality Rates Per 1 ,000 Population
13.6-14.1
10.7-12.9
8.2-10.5
6.7-7.5
4.6-6.1
Figure 1.C
North Carolina
Resident Data
1994-1998
Total Deaths - All Causes
Age-Adjusted Mortality Rates
Per 1,000 Population
11.4-12.1
10.1 -11.2
9.5-10.0
8.5-9.4
7.4-8.3
North Carolina
Resident Data
1994-1998
Figure 1.D
34
Heart Disease
Introduction
Heart disease is the leading cause of death in North Carolina and in the nation. In 1998, heart
disease was responsible for 19,441 deaths in North Carolina; accounting for 29 percent of all
deaths in the state. Heart disease has an overall mortality rate of 257.6 per 100,000 North Carolina
residents.
Differentials and Trends
In 1998, the age-adjusted heart disease mortality rate was 59 percent higher for males"(339.5 per
100,000 population) than for females (213.6). In addition, the 1998 age-adjusted heart disease
mortality rate was 26 percent higher for minorities than for whites (319.6 vs. 254.4 per 100,000
population). Between 1979 and 1998, the North Carolina age-adjusted heart disease mortality rate
declined by 34 percent. Despite the overall reduction in heart disease deaths, important differ-ences
exist in the rates of decline by race and sex. From 1979 to 1998, the age-adjusted heart
disease mortality rate decreased 37 percent among whites — from 402.0 to 254.4; but only 22
percent among minorities — from 409.6 to 319.6. During this same time period, the age-adjusted
heart disease death rate declined 39 percent among males, from 554.4 to 339.5, but only 28
percent among females, from 297.6 to 213.6.
These age-adjusted heart disease mortality trends indicate a growing gap between minorities and
whites, and a narrowing gap between males and females. In 1979, the heart disease mortality
rate for minorities and whites was essentially the same, but by 1998 the rate was 26 percent
higher for minorities than for whites. In contrast, the gap between males and females decreased
during this same period. The heart disease mortality rate for males was 86 percent higher for
males than for females in 1979, and 59 percent higher in 1998.
Risk Factors
Risk factors for heart disease include obesity, physical inactivity, poor nutrition, tobacco use, high
blood pressure, elevated cholesterol, and diabetes. 1 Changes in lifestyle factors, such as smoking
cessation and weight control, coupled with improved access to early detection and better medical
treatment have led to the decline in heart disease deaths during the past 20 years. The primary
modifiable risk factors for heart disease are tobacco use, physical inactivity, and inadequate nutri-tion.
2
Cigarette smoking is so significant a risk factor that the Surgeon General has called it "the most
important of the known modifiable risk factors for coronary heart disease in the United States". 3
Smokers are twice as likely as nonsmokers to suffer a heart attack and have two to four times the
risk of nonsmokers for sudden cardiac death. Further, smokers who have a heart attack are more
likely than nonsmokers to die and die suddenly (within an hour). 4 In 1997, 26 percent of North
Carolina adults were current smokers. This was the eleventh highest prevalence in the nation,
above the United States median of 24 percent. 5
Physically inactive people are almost twice as likely as those who engage in regular physical activ-ity
to develop heart disease. 6 Regular moderate-to-vigorous physical activity plays a significant role
in preventing heart disease, and helps to control other risk factors, such as obesity, high blood
35
pressure, and elevated cholesterol. 4 Risk from physical inactivity is comparable to the highly recog-nized
risks of smoking, high blood pressure, and elevated cholesterol. However, physical inactivity
is more prevalent than any of these risk factors. 6 Physical inactivity poses a serious health threat to
North Carolinians. In 1996, only 14 percent of North Carolina adults engaged in regular and
sustained physical activity. This was the eighth lowest prevalence in the nation, falling below the
United States median of 21 percent.
Poor diet is another leading contributor to heart disease. A diet high in fat contributes to elevated
cholesterol, obesity, and diabetes. 7 Despite having many healthy food options available, North
Carolinians generally consume a high-fat, low-fiber diet, and the proportion of who are overweight
is increasing. 5 In 1996, only 17 percent of North Carolina's adults reported eating at least five fruits
and vegetables daily. This was the fifth lowest prevalence in the nation, falling below the United
States median of 24 percent. Further, 31 percent reported being overweight, the twentieth highest
prevalence in the United States.
Geographic Patterns
While the heart disease death rate is decreasing overall in the state, relatively high unadjusted
rates remain in several parts of North Carolina. After adjusting for age, several pockets of counties
in the eastern part of the state and along the South Carolina border continue to have high rates,
indicating that these counties are experiencing high heart disease mortality that cannot be ex-plained
by age. These counties tend to be rural and have poorer socioeconomic profiles. In
contrast, urban counties, such as Buncombe, Mecklenburg, and Wake, exhibit relatively low rates
of age-adjusted heart disease mortality.
References
1. Hahn RA, Heath GW, Chang MH. Cardiovascular disease risk factors and preventive practices
among adults - United States, 1994. A behavioral risk factor atlas. Morbidity and Mortality
Weekly Report 1998; 47:35-69.
2. McGinnis JM, Foege WH. Actual causes of death in the United States. Journal of the American
Medical Association 1993; 270:2207-2212.
3. American Heart Association (AHA). (1999a). Cigarette smoking and cardiovascular diseases.
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cigcvd.html
4. American Heart Association (AHA). (1999b). Risk factors and coronary heart disease, http://
www.americanheart.org/Heart_and_Stroke_A_Z_Guide/riskfact.html
5. N.C. Heart Disease and Stroke Prevention Task Force. North Carolina plan to prevent heart
disease & stroke: 1999-2003. North Carolina Department of Health and Human Services, 1999.
6. American Heart Association (AHA). (1999c). Physical activity and cardiovascular health:
Factsheet. http://www.justmove.org/fitnessnews/healthf.cfm?Target=cardiofacts.html
7. American Heart Association (AHA). (1999d). Dietary/lifestyle interventions and the AHA diet.
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/dietlife.html
36
c
»- .2 V 4-1 arc
« 5
Heart Disease:
North Carolina Resident
Age-Adjusted* Death Rates by Race 1979-1998
500
400
300
200
100
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
— — White 402 395 390 375 377 365 357 354 345 333 3L5 312 305 300 294 285 280 272 260 254
—£—Minority 410 430 425 387 415 408 406 398 397 393 374 364 363 367 355 355 334 347 322 320
Year
'U.S. 2000 standard population
Figure 2.A
Heart Disease:
North Carolina Resident
Age-Adjusted* Death Rates by Sex 1979-1998
c
o
Q.
ru
O
£ 600
3
o.
o
a.
ooo
oo
400
200
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
•Male 554 548 537 503 514 501 487 472 466 463 432 424 411 406 403 394 382 371 350 340
-Female 298 300 297 287 291 282 280 283 276 263 253 252 249 247 238 233 227 225 216 214
Year
'U.S. 2000 standard population
Figure 2.B
37
TABLE 2
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Heart Disease
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
North Carolina 19,441 257.6 97,162 265.8 392.2 359.7 316.3 282.0
1 Alamance 351 288.5 1,736 295.1 400.2 337.8 304.5 258.8
2 Alexander 85 266.4 406 264.7 364.9 377.0 321.0 292.7
3 Alleghany 34 345.0 193 399.0 298.0 285.3 289.5 261.0
4 Anson 93 387.1 454 379.9 399.6 401.9 376.0 324.3
5 Ashe 74 312.3 399 341.9 395.1 341.7 289.2 246.8
6 Avery 59 385.1 314 411.7 481.4 425.4 377.5 348.3
7 Beaufort 199 457.0 896 413.4 417.2 420.5 369.0 358.0
8 Bertie 75 374.4 375 367.8 447.5 411.5 342.4 340.3
9 Bladen 128 416.0 569 378.2 446.5 410.7 365.7 336.2
10 Brunswick 196 291.2 960 305.1 394.6 352.0 321.3 293.3
11 Buncombe 634 328.0 3,063 322.5 355.9 315.4 274.6 257.3
12 Burke 265 315.1 1,190 289.7 383.6 396.8 335.1 277.9
13 Cabarrus 343 284.2 1,593 280.3 396.4 337.0 310.9 287.1
14 Caldwell 212 281.2 1,102 296.9 375.7 368.3 327.6 300.4
15 Camden 17 266.5 78 247.0 419.5 330.7 310.4 248.5
16 Carteret 190 320.6 917 315.2 452.6 378.1 297.3 298.1
17 Caswell 85 379.8 364 335.5 410.7 337.7 310.4 287.9
18 Catawba 345 262.3 1,610 251.8 400.9 380.2 318.3 264.5
19 Chatham 118 256.9 627 284.6 386.8 349.1 271.1 252.4
20 Cherokee 87 381.9 437 395.3 316.3 321.6 295.0 280.1
21 Chowan 52 361.6 261 368.8 312.9 327.8 313.5 277.0
22 Clay 38 461.3 160 405.7 436.8 320.5 267.0 274.7
23 Cleveland 279 303.9 1,609 357.8 468.3 400.2 371.4 336.0
24 Columbus 208 398.7 1,020 395.0 445.5 417.4 390.4 375.9
25 Craven 234 262.9 1,073 246.7 390.6 354.5 319.5 290.0
26 Cumberland 493 168.4 2,424 165.1 421.3 443.4 389.1 300.8
27 Currituck 46 268.0 214 263.1 442.2 417.2 316.3 280.4
28 Dare 63 223.9 300 226.2 349.0 303.2 263.6 274.4
29 Davidson 366 258.9 1,922 277.8 376.6 358.0 335.4 291.9
30 Davie 106 329.6 509 332.7 348.8 379.9 290.3 300.6
31 Duplin 124 280.2 718 331.4 425.1 397.5 329.1 313.5
32 Durham 410 204.2 2,195 224.6 382.0 329.1 272.6 278.6
33 Edgecombe 170 310.8 897 321.1 403.9 371.8 364.3 335.7
34 Forsyth 744 256.8 3,639 256.8 389.2 341.6 291.8 259.2
35 Franklin 106 238.5 555 260.9 431.2 359.2 316.4 267.9
36 Gaston 541 298.8 2,815 313.9 428.9 420.2 392.5 331.8
37 Gates 19 190.1 169 342.7 427.5 366.5 372.1 334.1
38 Graham 16 214.4 118 315.6 321.2 385.4 325.3 249.7
39 Granville 111 249.4 594 281.7 435.2 384.1 338.2 294.8
40 Greene 38 207.1 223 258.2 421.3 386.2 315.7 256.2
41 Guilford 855 220.3 4,461 236.4 362.9 334.0 293.2 246.4
42 Halifax 200 360.9 1,104 390.9 442.3 401.1 373.8 363.0
43 Harnett 190 227.3 1,028 259.4 475.0 409.7 340.3 292.1
44 Haywood 200 387.5 990 392.0 377.3 356.9 288.6 266.3
45 Henderson 261 322.7 1,467 377.2 321.2 289.4 268.3 231.1
46 Hertford 63 292.2 388 350.8 392.0 387.3 328.5 309.4
47 Hoke 49 163.1 265 187.9 350.5 331.9 346.6 256.4
48 Hyde 27 470.3 138 517.0 362.2 356.5 383.6 421.0
49 Iredell 340 299.5 1,567 293.9 385.6 354.6 315.7 289.7
50 Jackson 76 257.1 387 266.6 358.9 340.6 278.0 236.8
*Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
38
TABLE 2 (cont.)
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Heart Disease
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
51 Johnston 291 270.2 1,414 284.5 492.9 423.9 380.9 307.2
52 Jones 37 399.4 156 334.9 337.4 315.9 336.6 319.5
53 Lee 142 291.2 660 280.4 452.6 403.3 336.5 286.7
54 Lenoir 201 343.1 1,021 346.5 443.5 430.9 362.3 327.6
55 Lincoln 151 255.6 789 277.7 401.9 366.1 334.4 307.0
56 McDowell 127 316.6 581 302.9 387.4 380.6 351.3 261.7
57 Macon 110 390.7 557 413.8 341.5 300.5 250.1 243.3
58 Madison 62 329.9 291 320.9 368.3 336.5 280.9 243.2
59 Martin 81 316.0 438 339.7 425.8 410.9 329.9 314.6
60 Mecklenburg 1,066 170.7 5,517 186.1 363.6 327.7 286.6 253.8
61 Mitchell 63 430.8 319 435.2 367.8 312.4 307.0 302.5
62 Montgomery 79 319.6 369 304.7 434.3 343.6 332.1 307.8
63 Moore 273 385.5 1,213 356.7 373.6 343.2 266.4 241.7
64 Nash 239 271.2 1,212 283.2 425.8 404.8 350.0 302.2
65 New Hanover 360 242.6 1,864 261.4 400.5 353.1 299.5 274.4
66 Northampton 75 361.4 378 364.3 453.0 393.3 354.5 291.1
67 Onslow 209 140.3 982 132.4 396.0 309.0 311.8 326.0
68 Orange 155 141.8 802 150.4 322.9 274.8 242.5 217.1
69 Pamlico 50 413.4 206 344.9 405.3 311.4 273.8 257.8
70 Pasquotank 98 281.9 536 315.8 399.8 413.3 344.6 302.0
71 Pender 93 244.0 505 281.2 375.2 322.3 321.6 274.0
72 Perquimans 38 347.1 197 366.1 308.2 312.3 273.1 268.1
73 Person 93 279.3 507 312.6 444.0 363.9 309.2 284.7
74 Pitt 284 224.3 1,306 216.3 432.6 390.6 301.9 287.3
75 Polk 73 438.0 328 407.6 348.5 287.1 272.2 216.7
76 Randolph 312 251.3 1,547 260.9 358.3 346.5 312.4 274.7
77 Richmond 181 397.7 883 388.2 425.3 365.9 374.9 373.5
78 Robeson 332 290.1 1,636 292.1 407.3 408.1 380.6 358.3
79 Rockingham 257 286.7 1,373 309.2 401.1 396.3 327.5 275.9
80 Rowan 426 341.6 2,093 346.4 361.4 327.5 322.9 300.1
81 Rutherford 243 404.6 1,129 380.8 399.9 366.7 354.1 321.3
82 Sampson 165 309.5 818 317.2 439.4 393.8 350.3 288.7
83 Scotland 133 377.8 605 346.5 436.4 450.0 413.1 405.6
84 Stanly 209 375.9 973 356.6 400.3 358.3 333.1 327.6
85 Stokes 85 196.8 505 241.1 353.8 383.0 307.2 257.6
86 Surry 217 319.5 1,148 347.8 378.3 351.1 301.2 298.1
87 Swain 43 353.4 243 411.3 402.7 455.3 382.7 344.7
88 Transylvania 96 339.0 506 366.9 312.6 278.8 244.4 249.5
89 Tyrrell 18 462.1 68 360.5 502.0 476.5 408.0 281.3
90 Union 265 240.7 1,223 239.4 355.4 370.8 363.2 334.3
91 Vance 135 323.8 677 333.1 450.4 419.9 412.0 344.8
92 Wake 808 140.6 3,946 146.9 357.9 316.0 271.1 237.9
93 Warren 68 359.5 305 334.3 389.6 377.7 284.3 246.1
94 Washington 47 358.7 276 408.6 503.0 404.5 365.4 377.4
95 Watauga 75 183.2 427 211.7 320.7 309.9 242.2 246.3
96 Wayne 311 274.5 1,453 259.9 458.7 452.4 372.2 322.7
97 Wilkes 169 266.9 856 273.9 449.2 384.9 304.4 255.3
98 Wilson 223 321.4 1,099 321.5 397.6 393.9 346.5 329.6
99 Yadkin 112 314.1 491 285.2 324.1 350.3 307.6 246.6
100 Yancey 46 277.4 241 296.4 263.9 266.2 246.8 217.4
*Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
39
Heart Disease
Mortality Rates Per 100,000 Population
517.0
331.4-435.2
273.9 - 322.5
211.7-266.6
132.4-187.9
Figure 2.C
North Carolina
Resident Data
1994-1998
Heart Disease
Age-Adjusted Mortality Rates
Per 100,000 Population
405.6-421.0
358.0 - 377.4
319.5-348.3
274.0-314.6
216.7-268.1
Figure 2.
D
40
North Carolina
Resident Data
1994-1998
Cerebrovascular Disease
Introduction
In 1998 cerebrovascular disease, or stroke, claimed the lives of 5,434 North Carolinians with a
death rate of 72.0 per 100,000 population. It ranked as the third leading cause of death behind
heart disease and cancer, accounting for 8 percent of all deaths in the state. From 1979 to 1998,
the age-adjusted cerebrovascular disease death rate declined every year. During this time period,
the rate dropped 37 percent from 119.8 to 75.5 per 100,000 population.
Differentials and Trends
Despite this impressive drop in overall mortality, minorities continue to have exceedingly high rates
of cerebrovascular disease deaths. In 1998, the age-adjusted cerebrovascular disease death rate
for the minority population was 46 percent higher than for the white population (101.6 vs. 69.7 per
100,000 population). From 1979-1998, the rates diverged, decreasing less for the minority popula-tion
than for the white population (25 and 40 percent, respectively).
In 1998, the age-adjusted cerebrovascular disease death rate for males of all races was 10 percent
higher than for females (79.3 vs. 72.0 per 100,000 population). From 1979-1998, the gap be-tween
males and females has narrowed as the rate for males declined more than for females (40
and 35 percent, respectively).
According to 1997 data, North Carolina's cerebrovascular disease death rate is the fourth highest in
the nation. 1 This high ranking establishes North Carolina in the "stroke belt," which is an 8- to 10-
state region in the southeastern United States. Death rates in the stroke belt are 1.3 to 2.0 times
the national average. Individuals living in the stroke belt have a 43 percent greater risk than those
living elsewhere in the U.S. of death from a stroke. 2
Risk Factors
Many of the risk factors associated with cerebrovascular disease are the same as those for heart
disease: obesity, physical inactivity, cigarette smoking, high blood pressure, elevated cholesterol,
and diabetes. Additional risk factors include prior stroke, carotid artery disease, heart disease,
transient ischemic attacks, and high red blood cell count. 3 Minorities are also at greater risk of
dying from cerebrovascular disease. The large racial differences we see in cerebrovascular disease
death rates is, to some extent, due to a generally higher prevalence of risk factors (except for
smoking) and lower prevalence of preventive practices. 4
Geographic Patterns
Geographically, there is a scattering of counties with relatively high unadjusted rates, with several
pockets of high-rate counties in the eastern and western parts of the state. After adjusting for
age, the majority of high-rate counties are clustered in the east. The eastern part of the state is
included in the "buckle" of the stroke belt, along with the coastal regions of South Carolina and
Georgia. These areas have drastically elevated rates of stroke, even compared with the rest of the
stroke belt. 2
41
References
1. Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. National Vital Statistics
Reports 1999; 47(19). Hyattsville, Maryland: National Center for Health Statistics.
2. Howard SL, Anderson R, Johnson NJ, Sorlie P, Russell G, Howard VI Evaluation of social status
as a contributing factor to the stroke belt region of the US. Stroke 1997; 28:936-940.
3. American Heart Association (AHA), 1999. Stroke risk factors.
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/strokeri.html
4. Hahn RA, Heath GW, Chang MH. Cardiovascular disease risk factors and preventive practices
among adults - United States, 1994. A behavioral risk factor atlas. Morbidity and Mortality
Weekly Report 1998; 47:35-69.
42
»- .2
a re
Cerebrovascular Disease:
North Carolina Resident
Age-Adjusted* Death Rates by Race 1979-1998
200
Si
5 150
100
50
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
-White lid HO
-Minority 136 150
102 96
134
92
130
86 82 Nil
116 114 119
76
114
73
110
73
107
1992 1993 1994 1995 1996 1997 1998
71 72 75 ' 74 72 70 70
105 104 112 107 109 96 102
Year
*U.S. 2000 standard population
Figure 3.A
c
^ .2
are
<» 3
Cerebrovascular Disease:
North Carolina Resident
Age-Adjusted* Death Rates by Sex 1979-1998
150
100
50
-Male
- Female
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990
132 131 122 111 105 101 100 95 90 96 89 89
111 108 105 97 94 90 89 82 82 83 78 74
1991 1992 1993 1994 1995 1996 1997 1998
86 85 85 87 86 83 81 79
75 72 73 78 75 74 70 72
Year
'U.S. 2000 standard population
Figure 3.B
43
TABLE 3
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Cerebrovascular Disease
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
North Carolina 5,434 72.0 26,354 72.1 109.7 90.0 79.6 78.0
1 Alamance 115 94.5 543 92.3 109.3 77.3 78.1 81.8
2 Alexander 15 47.0 71 46.3 97.3 58.4 68.8 52.6
3 Alleghany 13 131.9 56 115.8 108.6 83.2 61.6 72.4
4 Anson 14 58.3 141 118.0 117.5 83.4 96.6 101.4
5 Ashe 23 97.1 111 95.1 71.3 62.1 71.1 67.4
6 Avery 15 97.9 40 52.4 70.0 56.8 38.5 44.7
7 Beaufort 28 64.3 188 86.7 134.3 112.1 79.2 75.3
8 Bertie 24 119.8 99 97.1 101.4 114.9 101.7 90.8
9 Bladen 35 113.7 193 128.3 183.6 100.5 96.2 115.8
10 Brunswick 58 86.2 220 69.9 88.2 68.2 61.3 71.4
11 Buncombe 154 79.7 821 86.4 90.9 87.8 66.5 68.3
12 Burke 72 85.6 252 61.3 94.7 70.3 51.1 59.6
13 Cabarrus 78 64.6 326 57.4 126.1 83.9 62.4 59.2
14 Caldwell 50 66.3 272 73.3 84.4 75.6 72.4 77.3
15 Camden 4 62.7 22 69.7 145.1 80.0 103.5 71.9
16 Carteret 36 60.7 183 62.9 59.8 73.3 70.5 60.9
17 Caswell 16 71.5 81 74.7 142.9 96.8 96.9 64.3
18 Catawba 85 64.6 477 74.6 112.2 79.9 71.5 81.3
19 Chatham 37 80.5 179 81.2 120.4 78.9 69.1 72.8
20 Cherokee 15 65.8 74 66.9 55 67.2 43.6 47.5
21 Chowan 9 62.6 65 91.8 137.2 117.4 101.5 68.1
22 Clay 11 133.5 30 76.1 46.7 61.0 39.6 52.4
23 Cleveland 79 86.1 389 86.5 89.1 75.2 78.0 81.8
24 Columbus 68 130.4 232 89.8 158.8 112.0 95.0 86.9
25 Craven 58 65.2 288 66.2 116.9 93.2 81.1 78.7
26 Cumberland 121 41.3 536 36.5 145.9 115.0 75.6 69.5
27 Currituck 11 64.1 48 59.0 57.5 84.2 62.1 66.7
28 Dare 11 39.1 69 52.0 103.1 68.4 56.9 65.7
29 Davidson 103 72.9 510 73.7 98.7 75.4 76.2 80.5
30 Davie 27 84.0 108 70.6 95.3 85.2 58.0 64.9
31 Duplin 45 101.7 261 120.5 151.4 108.4 123.3 114.9
32 Durham 137 68.2 550 56.3 96.6 76.9 73.3 70.1
33 Edgecombe 69 126.1 299 107.0 151.4 125.7 114.4 112.1
34 Forsyth 223 77.0 1,067 75.3 103.5 83.5 83.1 76.5
35 Franklin 40 90.0 182 85.6 97.8 82.8 81.2 88.9
36 Gaston 121 66.8 586 65.4 100.3 99.7 72.1 70.7
37 Gates 13 130.1 47 95.3 122.9 58.0 78.9 97.6
38 Graham 3 40.2 23 61.5 76.2 53.8 69.5 48.7
39 Granville 39 87.6 162 76.8 109.5 97.5 97.9 81.4
40 Greene 14 76.3 71 82.2 125.2 92.8 65.9 84.3
41 Guilford 288 74.2 1,471 78.0 117.5 96.3 86.0 82.6
42 Halifax 59 106.5 284 100.6 137.4 104.2 109.7 93.9
43 Harnett 56 67.0 246 62.1 107.3 91.5 63.1 71.1
44 Haywood 46 89.1 195 77.2 108.1 70.1 59.3 53.0
45 Henderson 100 123.6 416 107.0 90.7 70.8 63.5 64.1
46 Hertford 21 97.4 116 104.9 80.9 79.7 99.1 92.4
47 Hoke 21 69.9 69 48.9 112.7 72.7 98.5 67.4
48 Hyde 3 52.3 27 101.2 141.4 130.0 96.5 81.1
49 Iredell 91 80.2 435 81.6 121.9 94.3 80.6 83.0
50 Jackson 26 88.0 89 61.3 64.7 60.2 54.9 54.5
'Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
44
TABLE 3 (cont.)
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Cerebrovascular Disease
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
51 Johnston 65 60.3 359 72.2 95.5 85.3 85.7 80.3
52 Jones 11 118.7 59 126.7 158.0 123.3 98.2 121.5
53 Lee 30 61.5 137 58.2 123.3 72.8 62.0 59.8
54 Lenoir 73 124.6 354 120.1 170.4 116.4 103.3 115.6
55 Lincoln 41 69.4 192 67.6 121.9 107.3 97.1 77.1
56 McDowell 38 94.7 168 87.6 81.4 92.4 72.5 76.7
57 Macon 34 120.8 124 92.1 66.6 56.8 54.3 52.9
58 Madison 16 85.1 82 90.4 91.5 107.1 101.2 68.3
59 Martin 23 89.7 100 77.6 80.9 115.0 70.0 71.4
60 Mecklenburg 326 52.2 1,578 53.2 98.7 79.3 73.9 75.0
61 Mitchell 20 136.8 77 105.0 109.0 72.9 58.4 71.6
62 Montgomery 13 52.6 67 55.3 92.0 88.3 79.4 56.0
63 Moore 71 100.3 388 114.1 125.4 99.3 84.6 76.4
64 Nash 55 62.4 320 74.8 163.6 106.0 98.0 81.7
65 New Hanover 100 67.4 553 77.6 122.1 120.7 87.3 82.4
66 Northampton 19 91.6 133 128.2 135.4 111.4 102.3 105.2
67 Onslow 41 27.5 199 26.8 88.7 83.6 57.6 67.7
68 Orange 50 45.8 261 49.0 79.4 77.4 62.6 71.9
69 Pamlico 8 66.1 49 82.0 75.1 70.3 83.2 63.9
70 Pasquotank 29 83.4 136 80.1 107.2 65.9 84.6 75.5
71 Pender 36 94.5 163 90.8 140.3 102.8 75.8 91.4
72 Perquimans 18 164.4 77 143.1 119.1 94.5 82.0 104.1
73 Person 39 117.1 189 116.5 101.4 94.1 90.6 107.1
74 Pitt 86 67.9 446 73.9 115.6 112.5 94.8 100.7
75 Polk 24 144.0 97 120.5 103.7 68.8 66.0 60.0
76 Randolph 63 50.7 367 61.9 153.4 105.3 73.8 66.4
77 Richmond 32 70.3 186 81.8 133.5 111.6 89.4 79.5
78 Robeson 92 80.4 435 77.7 146.3 116.8 97.8 97.8
79 Rockingham 93 103.7 469 105.6 130.9 108.6 93.9 94.9
80 Rowan 100 80.2 527 87.2 104.6 93.7 83.4 75.6
81 Rutherford 39 64.9 299 100.8 122.2 93.8 74.9 84.7
82 Sampson 78 146.3 313 121.4 89.7 120.2 107.5 112.3
83 Scotland 26 73.9 134 76.8 133.9 133.8 89.7 92.3
84 Stanly 52 93.5 293 107.4 121.7 110.1 100.8 99.6
85 Stokes 53 122.7 197 94.0 94.9 83.3 88.0 105.3
86 Surry 62 91.3 282 85.4 84.0 76.3 79.3 73.5
87 Swain 14 115.1 40 67.7 81.2 69.8 89.4 56.0
88 Transylvania 14 49.4 112 81.2 77.3 66.3 51.9 54.7
89 Tyrrell 3 77.0 17 90.1 104.1 111.7 71.4 66.4
90 Union 49 44.5 246 48.2 115.0 69.2 79.6 68.3
91 Vance 40 95.9 232 114.2 109.7 75.8 86.0 120.9
92 Wake 264 45.9 1,233 45.9 101.6 84.7 80.1 77.7
93 Warren 22 116.3 109 119.5 114.2 111.9 104.9 88.7
94 Washington 5 38.2 35 51.8 105.9 79.5 61.5 46.9
95 Watauga 26 63.5 106 52.5 57.9 60.4 44.1 61.9
96 Wayne 87 76.8 392 70.1 132.6 112.4 90.2 89.0
97 Wilkes 58 91.6 267 85.4 76.8 87.5 85.8 83.1
98 Wilson 59 85.0 341 99.7 147.6 130.1 119.8 104.3
99 Yadkin 17 47.7 113 65.6 106.5 82.7 63.6 57.5
100 Yancey 20 120.6 81 99.6 90.2 59.3 87.9 72.8
"Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
45
Cerebrovascular Disease
Mortality Rates Per 100,000 Population
143.1
99.6-128.3
65.4-97.1
45.9 - 62.9
26.8-36.5
Figure 3.C
North Carolina
Resident Data
1994-1998
Cerebrovascular Disease
Age-Adjusted Mortality Rates
Per 100,000 Population
112.1 -121.5
97.6-107.1
78.7 - 94.9
63.9-77.7
44.7-61.9
Figure 3.
D
46
North Carolina
Resident Data
1994-1998
Cancer
Introduction
Cancer is a group of different diseases characterized by uncontrolled growth and spread of abnor-mal
cells. If the spread is not controlled, it can result in death. Cancer is caused by both external
(chemicals, radiation, and viruses) and internal (hormones, immune conditions, and inherited
mutations) factors. Causal factors may act together or in sequence to initiate or promote carcino-genesis,
and often ten or more years pass between exposures or mutations and detectable cancer.
Cancer is one of the most common causes of death in North Carolina — second only to heart
disease. However, while the age-adjusted death rate for heart disease has declined steadily over
the past twenty years, death rates for cancer have remained relatively unchanged over time. In
1998, a total of 15,327 North Carolinians died from cancer; representing about one in five deaths
in the state.
Differentials and Trends
The state's 1998 cancer death rate was 203.1 deaths per 100,000 population. The state's age-adjusted
cancer death rate for 1994-98 was two percent less compared to the previous five-year
period (1989-93), but still higher than the rate for 1984-88.
Comparisons of changes in the age-adjusted rates for race-sex groups also reveal small decreases
over the past few years. Death from cancer is rare under the age of 35 and the number of deaths
peaks in the 70-74 age group, in which 16 percent of 1997 cancer deaths occurred. Comparisons
of the age-adjusted rates for race-sex groups shows higher mortality rates among males, especially
minority males who have twice the overall cancer mortality rate of minority females (382.6 versus
192.1).
Risk Factors
Cancer is a number of different diseases and the risk factors vary by type. Cancer risk factors are
discussed in detail in the narratives for the four major types of cancer: colon and rectum; trachea,
bronchus, and lung; female breast; and prostate.
Geographic Patterns
Unadjusted and age-adjusted county cancer death rates for 1994-98 are mapped in figures 4.C and
4.D respectively. Crude mortality rates are higher in the northeastern and southwestern portions
of the state. These regions, which are some of the most rural parts of the state, have limited
resources to fight cancer. Without these resources, screening to detect cancer in early stages,
when cancer is more easily treated, is much more difficult. Also, care after diagnosis is less likely
to be effective since facilities are harder to reach, which is compounded if the cancer has been
diagnosed at a later stage. This is not a new pattern. When comparing the 1994-98 unadjusted
county death rates to the 1984-88 ones, the same regions and many of the same counties have
higher than average mortality rates. Comparisons of the age-adjusted rates do not change this
pattern. Counties in the northeastern part of the state have especially high cancer death rates
(Figure 4.D).
47
Cancer in Special Populations
Cancer in Minorities
Cancer does not occur among all groups of individuals at the same rate. Whites comprise 79
percent of North Carolinians; all other racial groups are considered minorities. Blacks represent
the largest minority population in North Carolina (although there are sizable numbers of American
Indians, Asians, and Hispanics). 1
In North Carolina in 1994 through 1998, cancer was the second leading cause of death for minority
males and females, with age-adjusted death rates of 382.6 and 192.1 per 100,000 population
respectively. 2 National data show that during the 1990s, mortality rates decreased among whites,
African Americans, and Hispanics; remained stable among Asian/Pacific Islanders; and increased
slightly among American Indians. African-American women are more likely to die of breast and
colon and rectum cancer than are women of any other racial and ethnic group. African-American
men have the highest mortality rates of colon and rectum, lung and bronchus, and prostate cancer.
African American men are more than twice as likely to die of prostate cancer than men of other
racial and ethnic groups. 3
In 1998, the five leading contributors to cancer mortality among minority males in North Carolina
were: lung, prostate, colorectal, pancreas, and stomach. For minority females, breast, lung,
colorectal, pancreas, and ovarian were the five leading causes of cancer deaths.
Rural Populations
Roughly one-half of all North Carolinians live in rural settings. Citizens who live in rural areas, such
as Appalachia, may have less access to state-of-the-art cancer care because of their isolated
residence. However, the cancer centers of the state are making efforts to reach rural citizens with
the latest cancer screening and treatment services. Several medical schools in the state have
research programs directed at improving services to rural areas. In addition, the National Cancer
Institute has developed special programs, such as the National Appalachian Leadership Initiative in
Cancer, specifically aimed to reach this population.
Other factors that may make rural populations more susceptible to cancer include different cultural
or nutritional patterns and specific occupational risks such as exposure to pesticides associated
with farming.
Cancer in Children
An estimated 1,600 cancer deaths are expected to occur among children ages 0-14 in 1999 in the
United States, 45 in North Carolina. Despite its rarity and the fact that cancer mortality rates
among children have declined 57 percent since the early 1970s, cancer is still the chief cause of
death by disease in children under age 15 (deaths from injury are the highest). Approximately one-third
of cancer deaths among children are from leukemia.
References
1. North Carolina Office of State Planning. July 1998 population estimates by race. Raleigh, North
Carolina, 1999.
2. North Carolina Central Cancer Registry, Cancer facts & figures - 1999. Raleigh, North Carolina,
1999.
3. Ries LAG, Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK (eds). SEER cancer statistics
review, 1973-1996. National Cancer Institute, Bethesda, Maryland, 1999.
48
a
M
ro
c
o
4-*
JO
3
Q.
O
Q.
OOOOo
Total Cancer:
North Carolina Resident
Age-Adjusted* Death Rates by Race 1979-1998
300
200
100
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
-B— White 182 190 187 186 187 187 189 191 195 202 200 205 201 205
-A— Minority 223 234 237 240 234 238 243 249 254 250 254 257 257 268
1993 1994 1995 1996 1997 1998
208 204 201 200 195 194
265 265 270 264 261 249
Year
'U.S. 2000 standard population
Figure 4.A
Total Cancer:
North Carolina Resident
Age-Adjusted* Death Rates by Sex 1979-1998
0)
Q.
ru
O
c
o
4-J
jU
3
Q.
O
Q.
OOooo
400
300
200
100
-—Male 261 274 271 268 27 1
-A— Female W4 150 148 151 147
-* * A * * * * *-
'U.S. 2000 standard population
1984 1985 1986 1987 1988 1989 1990 1991 1992
295
1993 1994 1995
288
168
1996
284
1997
276
164
1998
265 267
157
276
156
282
158
289 293 295 289
164
298 293
168
274
152 162 159
Year
165 169 169 166 161
Figure 4.B
49
TABLE 4
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Cancer - All Sites
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
North Carolina 15,327 203.1 75,094 205.4 195.6 203.1 214.2 210.1
1 Alamance 273 224.4 1,393 236.8 194.0 192.6 203.9 205.2
2 Alexander 70 219.4 288 187.8 176.7 154.0 192.2 191.0
3 Alleghany 32 324.7 160 330.8 165.2 200.1 178.4 228.3
4 Anson 54 224.8 291 243.5 165.6 182.6 207.1 210.1
5 Ashe 69 291.2 314 269.1 146.3 179.9 200.8 196.6
6 Avery 29 189.3 186 243.9 163.1 177.5 193.5 204.6
7 Beaufort 106 243.4 572 263.9 216.1 218.9 236.6 224.1
8 Bertie 50 249.6 308 302.1 240.9 225.4 250.2 274.9
9 Bladen 66 214.5 337 224.0 170.9 201.9 230.3 198.9
10 Brunswick 149 221.4 792 251.7 196.2 226.2 217.5 209.6
11 Buncombe 482 249.4 2,321 244.4 198.2 202.5 220.8 198.4
12 Burke 193 229.5 868 211.3 171.1 181.0 207.1 194.1
13 Cabarrus 237 196.4 1,169 205.7 184.4 196.8 204.2 202.6
14 Caldwell 145 192.3 764 205.8 167.3 205.4 210.4 198.2
15 Camden 20 313.6 102 323.0 242.1 221.0 201.2 298.7
16 Carteret 159 268.3 768 264.0 224.8 216.8 237.4 229.4
17 Caswell 70 312.8 299 275.6 164.2 188.4 214.5 233.9
18 Catawba 292 222.0 1,382 216.2 177.6 198.0 213.3 216.6
19 Chatham 112 243.8 480 217.9 169.9 186.1 213.0 189.0
20 Cherokee 74 324.8 308 278.6 197.2 169.0 192.1 195.7
21 Chowan 36 250.3 206 291.1 254.9 250.1 204.7 221.0
22 Clay 24 291.3 124 314.4 161.6 191.4 210.7 212.4
23 Cleveland 229 249.4 957 212.8 171.9 205.5 193.4 194.2
24 Columbus 118 226.2 616 238.5 185.9 200.1 222.3 218.5
25 Craven 201 225.8 919 211.3 233.4 204.6 223.7 230.1
26 Cumberland 408 139.4 2,115 144.1 206.0 216.6 233.6 231.9
27 Currituck 37 215.6 213 261.9 206.8 256.5 256.9 264.6
28 Dare 43 152.8 252 190.0 169.9 190.6 226.6 197.6
29 Davidson 253 179.0 1,390 200.9 184.0 194.5 192.4 199.4
30 Davie 71 220.8 316 206.5 204.3 233.2 185.5 180.7
31 Duplin 101 228.2 552 254.8 214.0 213.3 233.0 236.0
32 Durham 404 201.2 1,965 201.0 215.3 218.3 237.1 247.6
33 Edgecombe 133 243.1 669 239.5 204.1 228.5 251.9 245.9
34 Forsyth 628 216.8 3,012 212.5 194.5 196.8 212.6 212.0
35 Franklin 88 198.0 444 208.7 174.3 173.6 206.0 211.8
36 Gaston 362 200.0 2,011 224.3 193.5 201.2 216.1 229.3
37 Gates 25 250.2 130 263.6 192.1 247.5 220.9 249.1
38 Graham 17 227.8 116 310.2 181.9 223.6 188.5 236.3
39 Granville 112 251.6 477 226.2 202.3 177.7 214.6 231.0
40 Greene 29 158.1 176 203.8 200.1 177.5 186.1 195.8
41 Guilford 776 199.9 3,928 208.2 215.8 207.5 217.5 212.0
42 Halifax 129 232.8 723 256.0 203.2 199.5 226.9 238.4
43 Harnett 178 212.9 845 213.3 193.2 227.0 223.7 231.4
44 Haywood 137 265.4 653 258.6 172.3 189.5 195.0 176.9
45 Henderson 232 286.8 1,163 299.0 177.7 187.1 206.0 192.3
46 Hertford 58 269.0 308 278.5 198.6 217.6 253.4 250.1
47 Hoke 44 146.5 224 158.8 169.9 191.1 264.0 203.6
48 Hyde 12 209.0 63 236.0 156.1 225.1 247.1 194.2
49 Iredell 223 196.4 1,133 212.5 171.5 188.5 204.0 202.8
50 Jackson 74 250.4 320 220.5 170.8 178.4 189.5 194.8
^Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
50
TABLE 4 (cont.)
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Cancer - All Sites
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
51 Johnston 230 213.5 1,050 211.2 209.4 194.2 202.9 215.1
52 Jones 29 313.0 129 277.0 180.4 198.8 161.9 246.1
53 Lee 107 219.5 534 226.9 224.8 202.3 222.2 215.0
54 Lenoir 137 233.8 713 242.0 217.5 216.4 233.9 219.7
55 Lincoln 119 201.4 532 187.2 183.6 187.2 211.7 192.8
56 McDowell 102 254.3 453 236.2 168.8 190.5 202.6 203.0
57 Macon 69 245.1 399 296.4 194.9 192.4 181.9 182.3
58 Madison 39 207.5 217 239.3 178.4 184.2 172.4 186.6
59 Martin 63 245.8 317 245.9 208.5 201.2 239.3 216.2
60 Mecklenburg 970 155.3 4,738 159.8 208.0 209.9 219.5 206.3
61 Mitchell 46 314.5 212 289.2 186.8 194.3 215.0 209.9
62 Montgomery 62 250.8 261 215.5 203.8 190.5 211.1 213.5
63 Moore 215 303.6 1,016 298.8 216.1 215.9 204.3 199.1
64 Nash 176 199.7 873 204.0 202.0 201.9 223.6 207.5
65 New Hanover 301 202.9 1,464 205.3 223.4 244.6 245.1 201.9
66 Northampton 52 250.6 310 298.8 221.2 227.9 221.0 233.4
67 Onslow 169 113.4 789 106.4 208.0 223.8 233.6 233.6
68 Orange 181 165.6 787 147.6 183.0 206.5 205.4 205.2
69 Pamlico 43 355.5 177 296.3 208.8 230.9 245.5 218.6
70 Pasquotank 68 195.6 386 227.4 218.7 242.9 226.4 218.1
71 Pender 85 223.0 407 226.7 232.0 224.7 213.2 201.8
72 Perquimans 35 319.7 165 306.6 212.8 184.5 218.6 227.6
73 Person 70 210.2 375 231.2 191.1 184.2 209.8 208.7
74 Pitt 203 160.3 1,088 180.2 217.9 213.2 233.5 230.3
75 Polk 45 270.0 254 315.6 175.6 190.9 201.4 184.5
76 Randolph 233 187.7 1,166 196.7 172.6 190.3 200.8 196.9
77 Richmond 98 215.4 520 228.6 198.0 195.5 223.0 212.5
78 Robeson 216 188.8 1,107 197.7 192.8 201.9 215.2 230.0
79 Rockingham 243 271.1 1,153 259.6 191.2 197.2 220.6 228.1
80 Rowan 289 231.7 1,411 233.5 180.1 196.0 215.5 204.7
81 Rutherford 152 253.1 707 238.5 176.9 187.6 198.4 201.9
82 Sampson 122 228.8 617 239.3 204.9 195.2 201.3 214.8
83 Scotland 58 164.8 346 198.2 182.8 220.2 224.5 218.4
84 Stanly 117 210.4 642 235.3 179.8 195.7 191.0 210.7
85 Stokes 96 222.2 410 195.7 185.1 187.3 217.2 199.2
86 Surry 185 272.3 802 243.0 194.2 182.5 190.2 204.3
87 Swain 28 230.1 154 260.7 188.2 206.6 202.7 218.8
88 Transylvania 94 332.0 396 287.1 186.5 197.1 197.0 197.9
89 Tyrrell 8 205.4 54 286.3 229.8 217.6 179.2 218.0
90 Union 182 165.3 870 170.3 178.7 204.0 208.9 208.9
91 Vance 118 283.0 523 257.4 196.7 231.9 244.1 258.8
92 Wake 760 132.2 3,580 133.3 205.3 203.7 203.6 196.0
93 Warren 65 343.6 270 295.9 232.3 247.0 238.7 223.0
94 Washington 54 412.1 214 316.8 221.7 259.1 246.1 283.0
95 Watauga 69 168.6 318 157.6 169.6 164.1 170.1 177.0
96 Wayne 247 218.0 1,105 197.7 188.7 232.1 231.0 226.4
97 Wilkes 142 224.3 649 207.7 183.3 167.5 186.3 188.4
98 Wilson 161 232.0 763 223.2 214.1 219.4 238.6 218.8
99 Yadkin 80 224.4 370 214.9 166.8 185.9 195.5 183.2
100 Yancey 30 180.9 179 220.2 165.8 212.4 158.2 163.2
*Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
51
Cancer - All Sites
Mortality Rates Per 100,000 Population
286.3 - 330.8
251.7-278.6
180.2-245.9
133.3-170.3
106.4
Figure 4.C
North Carolina
Resident Data
1994-1998
Cancer All Sites
Age-Adjusted Mortality Rates
Per 100,000 Population
274.9 - 298.7
245.9 - 264.6
208.7 - 238.4
186.6-207.5
163.2-184.5
North Carolina
Resident Data
1994-1998
Figure 4.D
52
Cancer of the Colon & Rectum
Introduction
In 1998, a total of 1,517 North Carolinians died of colorectal cancer. This accounted for 9.9 per-cent
of the state's total cancer deaths and 2.2 percent of all resident deaths. The 1998 age-adjusted
mortality rate for colon and rectal cancer was 20.4 deaths per 100,000 population. Dur-ing
the five-year period 1994-1998, colon and rectum cancer ranked second among cancer deaths
in North Carolina. During this same time period, colon and rectum cancer was among the top ten
leading causes of death in North Carolina.
Differentials and Trends
The five-year age-adjusted mortality rate during 1994-1998 was 4.5 percent lower than the 1984-
1988 rate. During this time period (1994-1998), minority males had the highest age-adjusted
mortality rate of 31.7 deaths per 100,000 population followed by minority females at 25.2 deaths
per 100,000 population. During this same time period, white females experienced the lowest age-adjusted
mortality rate of 16.9 deaths per 100,000 population, while white males had a rate of
24.4 deaths per 100,000 population.
There is a wide sex differential in mortality for colorectal cancer. During 1994-1998, North
Carolina's age-adjusted death rate was 44.4 percent higher for white males than for white females
and 25.8 percent higher for minority males than for minority females. There is also a sizeable
difference in age-adjusted death rates for racial groups. The 1994-1998 minority male rate was
29.9 percent higher than that for white males, while the minority female rate was 49.1 percent
higher than the rate for white females.
In North Carolina, colorectal cancer deaths do not generally occur prior to age 45, with the
colorectal cancer mortality rate peaking at ages 75+. The same is true for colorectal cancer
incidence rates for North Carolina.
Colorectal cancer is the third most common malignancy in terms of new cases and deaths among
men and women in the United States. The incidence rates for colorectal cancer have declined
noticeably in the 1990's. The risk of developing colorectal cancer increases with age in men and
women; however, at all ages, men are more likely to develop colorectal cancer than women. Men
are also more likely to die from colorectal cancer than women. 1 Among North Carolina residents,
there will be a projected 4,350 new colorectal cases in 1999. 2
When colorectal cancer is detected in an early, local stage, the 5-year relative survival rate is 90
percent. After the cancer has spread regionally to involve adjacent organs or lymph nodes, the
survival rate drops to 65 percent, while the rate for persons with distant metastases is around 8
percent. 1 In North Carolina, approximately 35 percent of colorectal cases are diagnosed at the
early stage.
53
Risk Factors
Inadequate nutrition is thought to be one of the greatest risk factors for developing colorectal
cancer. While there is no recognized way to prevent colorectal cancer, it is thought that people can
reduce their risk by eating a nutritious diet - particularly one that is low in fat and high in fiber.
Dietary factors that are thought to play a protective role against the development of colorectal
cancer include consuming high-fiber foods (fruits, vegetables, beans, legumes, and grains), crucif-erous
vegetables (cabbage, broccoli, cauliflower, and brussels sprouts), and vitamins A and C. 3
Other risk factors that have been associated with an increased risk of colorectal cancer are physical
inactivity and a family history of colorectal cancer or polyps. 4
Like many other cancers, failure to have timely and appropriate screening also increases the risk of
colorectal cancer death. It is recommended that beginning at age 50, men and women have
cancer screening tests performed such as: digital rectal examination, fecal occult blood test, sig-moidoscopy,
colonscopy, or double-contrast barium enema.4 These tests have resulted in a reduc-tion
in the number of deaths from colorectal cancer, by detecting and removing adenomatous
polyps before these become cancers or by detecting and removing early stage colorectal cancers
when the disease is still highly curable. However, a larger fraction of colorectal cancers could be
prevented by appropriate modifications in diet and the adoption of regular physical activity.
Geographic Patterns
As shown in the unadjusted mortality rate map, higher mortality rates tend to be found in the
northeastern part of North Carolina. The high unadjusted mortality rates found in the northeast are
especially evident in counties such as Northampton, Hertford, Bertie, Chowan, and Gates. Age-adjusted
colorectal cancer mortality rates were also higher in the northeast during the five-year
period (1994-1998). Higher mortality rates in this region could be associated with poor screening
(screening at later stages) and insufficient access to health care in this region compared with other
parts of the state.
References
1. Ries LA, Kosary CL, Hankey BF, Miller BA, Edwards BK (eds). SEER cancer statistics review,
1973-1996. National Cancer Institute. Bethesda, Maryland, 1999.
2. North Carolina Central Cancer Registry. Cancer facts and figures - 1999. Raleigh, North Caro-lina,
1999.
3. Kendall, P. Diet Can Reduce Risk of Cancer - 1997.
http://www.colostate.edu/Depts/CoopExt/PUBS/COLUMNNN/nn970430.htm
4. American Cancer Society. Cancer facts and figures - 1999.
54
c
v. .2
Q.JU
8 8
Colorectal Cancer:
North Carolina Resident
Age-Adjusted* Death Rates by Race 1979-1998
40
30
20
10
979 1980 1981 1982 1983 1984 1985 1986
-White 23 22 21 21 21
1990 1991 1992 1993 1994 1995 1996 1997
21 22 21 22 21 21 20 22 21 21 22 20
-Minority 24 24 25 27 25 ! 23 30 29 26 27 27 2 7 27 j 26 | 29 ; 28 | 29 | 27 28 25
Year
*U.S. 2000 standard population
Figure 5.A
Colorectal Cancer:
North Carolina Resident
Age-Adjusted* Death Rates by Sex 1979-1998
>-.2
0) *j 30
Q. fO
0) 3
s °- A)
*(D O O.
eath ,000
10
og 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
— — Male 26 27 26 24 26 24 24 28 27 27 28 26 26 27 26 25 28 26 25 24
—A—Female 21 20 20 21 18 19 21 21 19 20 .'II
Year
*U.S. 2000 standard population
Figure 5.B
55
TABLE 5
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Cancer - Colon, Rectum, and Anus
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
North Carolina 1,517 20.1 7,518 20.6 22.2 22.3 22.1 21.3
1 Alamance 23 18.9 140 23.8 20.0 22.9 21.2 20.9
2 Alexander 6 18.8 28 18.3 12.5 26.8 20.6 18.4
3 Alleghany 5 50.7 20 41.3 18.7 15.8 14.1 27.2
4 Anson 7 29.1 41 34.3 17.0 14.5 23.0 28.9
5 Ashe 5 21.1 27 23.1 17.0 14.0 18.6 16.7
6 Avery 6 39.2 14 18.4 7.4 21.9 26.1 15.0
7 Beaufort 10 23.0 50 23.1 23.9 19.0 19.7 19.9
8 Bertie 7 34.9 35 34.3 36.0 23.9 30.7 31.5
9 Bladen 9 29.2 40 26.6 13.9 22.0 22.6 24.1
10 Brunswick 12 17.8 89 28.3 16.6 23.6 21.9 23.2
11 Buncombe 50 25.9 235 24.7 22.1 20.8 23.6 19.9
12 Burke 24 28.5 84 20.4 23.0 18.6 22.9 19.1
13 Cabarrus 16 13.3 106 18.7 21.6 23.7 19.9 18.4
14 Caldwell 10 13.3 66 17.8 21.5 18.3 20.7 17.1
15 Camden 4 62.7 9 28.5 18.9 31.5 23.1 26.2
16 Carteret 9 15.2 66 22.7 22.4 26.7 22.5 20.3
17 Caswell 4 17.9 30 27.7 12.1 21.0 28.4 23.5
18 Catawba 36 27.4 165 25.8 21.3 24.7 25.0 26.2
19 Chatham 9 19.6 52 23.6 19.8 23.9 20.0 20.8
20 Cherokee 10 43.9 29 26.2 15.5 15.5 18.8 19.1
21 Chowan 1 7.0 24 33.9 31.3 26.2 39.0 25.0
22 Clay 1 12.1 12 30.4 20.1 23.6 18.6 20.2
23 Cleveland 26 28.3 88 19.6 25.3 25.3 22.7 17.9
24 Columbus 11 21.1 49 19.0 12.7 15.6 20.5 18.2
25 Craven 15 16.9 100 23.0 25.0 21.0 21.4 25.8
26 Cumberland 30 10.2 151 10.3 23.0 23.6 24.9 17.3
27 Currituck 5 29.1 21 25.8 30.5 25.2 18.6 29.3
28 Dare 3 10.7 20 15.1 27.5 28.8 19.6 17.0
29 Davidson 25 17.7 130 18.8 20.7 17.9 20.2 18.9
30 Davie 5 15.5 37 24.2 26.5 27.0 27.7 21.4
31 Duplin 14 31.6 64 29.5 18.6 18.8 25.5 27.0
32 Durham 34 16.9 197 20.2 22.5 24.7 23.3 24.8
33 Edgecombe 17 31.1 72 25.8 25.3 23.1 23.4 26.5
34 Forsyth 72 24.9 316 22.3 23.8 21.9 21.1 22.3
35 Franklin 7 15.8 53 24.9 18.7 17.8 20.0 25.2
36 Gaston 39 21.5 200 22.3 21.8 20.7 21.3 23.2
37 Gates 2 20.0 20 40.6 31.5 23.8 23.8 37.8
38 Graham 3 40.2 11 29.4 21.3 22.5 18.0 23.6
39 Granville 9 20.2 44 20.9 19.1 24.1 19.1 21.2
40 Greene 3 16.4 14 16.2 16.9 16.5 23.7 15.9
41 Guilford 70 18.0 389 20.6 23.7 23.0 22.9 21.2
42 Halifax 16 28.9 81 28.7 22.9 18.2 24.6 26.6
43 Harnett 20 23.9 100 25.2 23.4 21.8 21.7 27.8
44 Haywood 10 19.4 57 22.6 18.7 20.0 18.7 15.4
45 Henderson 28 34.6 123 31.6 22.0 24.4 23.6 20.5
46 Hertford 6 27.8 36 32.6 29.8 27.9 31.5 29.2
47 Hoke 4 13.3 23 16.3 23.1 15.2 31.5 20.2
48 Hyde 2 34.8 9 33.7 10.2 20.7 22.1 28.5
49 Iredell 25 22.0 118 22.1 21.1 22.6 25.2 21.6
50 Jackson 10 33.8 28 19.3 11.4 12.5 18.4 17.6
Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
56
TABLE 5 (cont.)
1998 NORTH CAROLINA RESIDENT MORTALITY STATISTICS:
Cancer - Colon, Rectum, and Anus
GEOGRAPHIC 1998 DEATHS 1994-98 DEATHS AGE-ADJUSTED DEATH RATES*
AREA Number Rate* Number Rate* 1979-1983 1984-1988 1989-1993 1994-1998
51 Johnston 18 16.7 93 18.7 26.3 14.2 19.9 19.4
52 Jones 3 32.4 15 32.2 15.3 21.9 20.7 28.5
53 Lee 8 16.4 55 23.4 24.9 22.1 18.8 22.6
54 Lenoir 19 32.4 102 34.6 18.8 28.3 24.4 32.2
55 Lincoln 15 25.4 58 20.4 24.0 26.1 29.1 21.4
56 McDowell 19 47.4 54 28.2 19.3 20.8 17.6 24.7
57 Macon 4 14.2 41 30.5 21.4 26.5 15.0 18.0
58 Madison 4 21.3 17 18.7 16.3 12.8 10.8 15.0
59 Martin 6 23.4 40 31.0 16.6 23.8 26.5 26.9
60 Mecklenburg 81 13.0 447 15.1 24.3 23.5 19.7 20.0
61 Mitchell 4 27.4 19 25.9 17.9 22.5 20.7 18.4
62 Montgomery 11 44.5 32 26.4 24.0 30.2 20.0 26.4
63 Moore 18 25.4 118 34.7 29.3 24.6 23.2 23.4
64 Nash 21 23.8 87 20.3 27.1 18.9 20.1 20.9
65 New Hanover 27 18.2 124 17.4 25.7 33.6 25.5 17.5
66 Northampton 11 53.0 38 36.6 29.4 21.1 28.9 29.7
67 Onslow 15 10.1 76 10.2 21.0 26.8 26.6 23.8
68 Orange 22 20.1 78 14.6 21.4 23.5 20.2 20.5
69 Pamlico 4 33.1 14 23.4 26.1 37.2 20.6 17.5
70 Pasquotank 5 14.4 50 29.5 22.5 32.1 26.0 27.9
71 Pender 6 15.7 33 18.4 21.8 21.8 21.9 16.2
72 Perquimans 2 18.3 14 26.0 21.3 28.8 19.4 18.9
73 Person 9 27.0 54 33.3 11.7 15.6 18.0 30.5
74 Pitt 18 14.2 109 18.1 22.2 21.1 24.5 23.3
75 Polk 8 48.0 36 44.7 25.7 22.7 18.6 24.8
76 Randolph 23 18.5 104 17.5 23.0 25.3 23.0 17.8
77 Richmond 10 22.0 68 29.9 24.6 19.0 26.7 27.6
78 Robeson 22 19.2 102 18.2 17.9 21.0 21.8 21.9
79 Rockingham 24 26.8 110 24.8 21.6 17.1 22.1 21.9
80 Rowan 23 18.4 126 20.9 25.3 23.6 22.3 18.2
81 Rutherford 15 25.0 75 25.3 23.0 21.6 24.4 21.4
82 Sampson 14 26.3 66 25.6 25.3 20.3 23.0 23.2
83 Scotland 5 14.2 41 23.5 15.0 17.7 23.2 25.9
84 Stanly 13 23.4 80 29.3 22.3 26.7 15.2 26.2
85 Stokes 10 23.1 37 17.7 14.0 14.4 12.3 18.8
86 Surry 19 28.0 78 23.6 21.6 19.8 15.8 20.1
87 Swain 2 16.4 11 18.6 26.7 23.1 25.9 15.9
88 Transylvania 8 28.3 32 23.2 23.9 19.1 27.1 17.4
89 Tyrrell 1 25.7 7 37.1 39.6 27.8 38.8 29.1
90 Union 18 16.3 81 15.9 18.8 25.8 21.1 20.0
91 Vance 12 28.8 46 22.6 21.5 26.4 25.5 23.1
92 Wake 72 12.5 356 13.3 21.3 25.0 20.1 20.1
93 Warren 6 31.7 26 28.5 28.8 16.1 30.8 21.3
94 Washington 6 45.8 19 28.1 27.9 30.9 37.1 25.6
95 Watauga 3 7.3 27 13.4 22.0 14.0 20.2 15.4
96 Wayne 27 23.8 105 18.8 22.6 26.4 28.1 22.3
97 Wilkes 20 31.6 61 19.5 21.0 18.4 20.6 17.7
98 Wilson 21 30.3 73 21.4 21.2 18.2 20.9 21.3
99 Yadkin 7 19.6 48 27.9 19.5 18.1 18.7 23.9
100 Yancey 3 18.1 22 27.1 19.0 20.2 16.8 19.9
*Death rates with a small number of deaths in the numerator should be interpreted with caution. SEE TECHNICAL NOTES.
57
Cancer - Colon, Rectum and Anus
i v—'
^
i. ?
Mortality Rates Per 100,000 Population
40.6-44.7
31.6-37.1
22.1 -31.0
13.3-21.4
10.2-10.3
Figure 5.C
North Carolina
Resident Data
1994-1998
Cancer - Colon, Rectum and Anus
Age-Adjusted Mortality Rates
Per 100,000 Population
37.8
30.5-32.2
24.7 - 29.7
19.9-24.1
150-194
Figure 5.
D
58
North Carolina
Resident Data
1994-1998
Cancer of the Trachea, Bronchus, & Lung
Introduction
Lung cancer continues to be the leading cause of cancer death for both men and women in the
United States. In 1999, an estimated 160,000 people (mostly ages 50 and over) died in the United
States of lung cancer: over 94,000 men and about 66,000 women, more deaths than from breast,
prostate, and colorectal cancer combined. 1
Differentials and Trends
In 1998 a total of 4,692 North Carolinians died from lung cancer. This accounted for 30:6 percent
of the state's cancer deaths and 6.9 percent of all deaths. Although lung cancer has long been the
leading cause of cancer death among men, it became the leading cause of cancer death among
women in North Carolina in 1990, exceeding breast cancer. In North Carolina, the age-adjusted
mortality rate in 1994-1998 was 62.6 per 100,000 population. This represented a 14 percent in-crease
over the 1984-88 rate and 2 percent increase over the 1989-93 mortality rate.
In every ethnic group, men have much higher lung cancer incidence and mortality rates than
women. In 1993-1997, North Carolina minority males had the highest age-adjusted incidence rate
followed by white males, white females, and minority females. African-American men have the
highest lung cancer incidence and mortality rates. The American Cancer Society estimates approxi-mately
171,600 new cases of lung cancer will be diagnosed in the United States in 1999. That is
about 13 percent of all newly diagnosed cancers. 1 North Carolina projects 5,295 new lung cancer
cases in 1999. The incidence and mortality rates, which until recently had been increasing steadily
for both sexes, are now decreasing among men but continue to increase among women. This
decline in lung cancer mortality represents more than half of the overall drop in cancer mortality
among men over the past several years. North Carolina incidence rates are quite similar to those of
the nation at large.
Early detection is very difficult because symptoms often do not appear until the disease is in an
advanced stage. For those who stop smoking when pre-cancerous changes are found, damaged
lung tissue often returns to normal. Chest x-ray, analysis of cells contained in sputum, and
fiberoptic examination of the bronchial passage assist diagnosis. Warning signals include persistent
cough, sputum streaked with blood, chest pain, and recurring pneumonia or bronchitis.
The one-year relative survival rate for lung cancer has increased from 32 percent in 1973 to 41
percent in 1996, largely due to improvements in surgical techniques. The 5-year survival rate for
lung cancer is only 14 percent in all patients for all stages combined. For African Americans diag-nosed
during 1989-1995, the 5-year survival rate was only 11 percent, compared to 14 percent for
whites. The survival rate is 49 percent for cases detected early when the disease is still localized,
but only 19 percent of lung cancers in North Carolina residents are discovered early. Overall, lung
cancer 5-year relative survival rates are very low. 2
Lung cancer is the leading cause of cancer death in African Americans, a