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October 11, 1995, Vol 274, No. 14 >
ARTICLE | October 11, 1995

Trends of Diarrheal Disease—Associated Mortality in US Children, 1968 Through 1991 FREE

Paul E. Kilgore, MPH, MD; Robert C. Holman, MS; Matthew J. Clarke, MA; Roger I. Glass, MD, PhD
[+] Author Affiliations

Reprint requests to the Viral Gastroenteritis Section, Mailstop G-04, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA 30333 (Dr Kilgore).


JAMA. 1995;274(14):1143-1148. doi:10.1001/jama.1995.03530140055032
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References

Objectives.  —To describe temporal patterns in mortality related to diarrheal disease in US children and to assess progress toward its prevention and control.

Design.  —Retrospective analyses of death certificate data on diarrhea of all causes compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Ga.

Patients.  —Children aged 1 month through 4 years who died with diarrhea.

Setting.  —United States, 1968 through 1991.

Results.  —A total of 14137 deaths associated with diarrhea among children were reported in the United States between 1968 and 1991. Of these, 78% occurred in infants (ie, aged 1 to 11 months); the median age at the time of death has declined from 5 to 1.5 months. Diarrheal disease mortality dropped by approximately 75% during the first 18 years of the study, but no decline has occurred since 1985. Infant mortality due to diarrhea (per 100 000 live births) averaged 12.8 and was found to be high for blacks (33.1) and for residents of the southern United States (18.5). The infant mortality due to diarrhea from 1986 through 1991 is 5.9. Peaks in winter deaths previously associated with rotavirus were prominent in the early years among infants aged 4 through 11 months. Such peaks have virtually disappeared since 1985. Diarrhea was the principal cause of death, as the leading associated diagnoses (electrolyte disorders [30%], cardiac arrest [16%], shock [8%], and nausea/vomiting [4%]) were commonly recognized complications of diarrhea. Since 1979, prematurity has emerged as a common associated diagnosis.

Conclusions.  —Diarrheal deaths nationwide have declined 75% from 1968 to 1985 but stabilized since then at about 300 deaths per year. Because many of these deaths may still be preventable by early rehydration, future prevention efforts should be directed at educating health care providers about the continuing problem and recognition of the high-risk infant and at teaching mothers of such infants to begin rehydration early and to seek medical attention when their infant develops diarrhea.(JAMA. 1995;274:1143-1148)

REFERENCES

1 +
Bern C, Martines J, de Zoysa I, Glass RI.  The magnitude of the global problem of diarrhoeal disease: a ten year update. Bull World Health Organ . 1992;;70:705-714.
2 +
Lew JF, Glass RI, Gangarosa RE, Cohen IP, Bern C, Moe CL.  Diarrheal deaths in the United States, 1979-1987: a special problem for the elderly. JAMA . 1991;;265:3280-3284.
3 +
Garthright WE, Archer DL, Kvenberg JE.  Estimates of incidence and costs of intestinal infectious diseases in the United States. Public Health Rep . 1988;;103:107-115.
4 +
Glass RI, Lew JF, Gangarosa RE, LeBaron CW, Ho MS.  Estimates of the morbidity and mortality from diarrheal diseases in American children. J Pediatr . 1991;;118:527-533.
5 +
Gangarosa RE, Glass RI, Lew JF, Boring JR.  Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol . 1992;; 135:281-290.
6 +
Ho M-S, Glass RI, Pinsky PF, et al.  Diarrheal deaths in American children: are they preventable? JAMA . 1988;;260:3281-3285.
7 +
Bern C, Lew J, McFeeley P, Ing RT, Glass RI.  Diarrheal deaths in children living in New Mexico: toward a strategy of preventive interventions. J Pediatr . 1993;;122:920-922.
8 +
Meyers A, Siegel B, Vinci R.  Economic barriers to the use of oral rehydration therapy: a case report. JAMA . 1991;;265:1724-1725.
9 +
LeBaron CW, Lew J, Glass RI, Weber JM, Ruiz-Palacios GM, the Rotavirus Study Group.  Annual rotavirus epidemic patterns in North America: results of a five-year retrospective survey of 88 centers in Canada, Mexico, and the United States. JAMA . 1990;;264:983-988.
10 +
National Center for Health Statistics, US Dept of Health and Human Services. Multiple Cause of Death for ICD-9 Data [public use data tape documentation] . Hyattsville, Md: National Center for Health Statistics; 1993;.
11 +
World Health Organization. International Classification of Diseases, Eighth Revision, Adapted for Use in the United States . Washington, DC: US Government Printing Office; 1975;:1.
12 +
World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death . Geneva, Switzerland: World Health Organization; 1977;:1.
13 +
Chamblee RF, Evans MC.  TRANSAX, the NCHS system for producing multiple cause-of-death statistics, 1968-78. Vital Health Stat 1 .1986;;No. (20) .
14 +
Israel RA, Rosenberg HM, Curtin LR.  Analytical potential for multiple cause-of-death data. Am J Epidemiol . 1986;;l24:161-179.
15 +
National Center for Health Statistics, US Dept of Health and Human Services. Public Use Data Tape Documentation, 1991, Detail Natality . Hyattsville, Md: National Center for Health Statistics; 1993;.
16 +
Bureau of the Census. 1980 Census of Population, Vol 1: Characteristics of the Population . PC80-1-B1, 1981;:91-110. Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Health Statistics; 1981. US Dept of Health and Human Services publication PHS 91-1101.
17 +
KIeinbaum DG, Kupper LL, Muller KE. Applied Regression Analysis and Other Multivariable Methods . Boston, Mass: PWS-Kent Publishing Company; 1988;.
18 +
Klein JO, Brunell PA, Cherry JD, Fulginiti VA. Report of the Committee on Infectious Diseases, Redbook . 19th ed. Evanston, Ill: American Academy of Pediatrics; 1982;.
19 +
Woods PA, Gentsch J, Gouvea V, et al.  Distribution of serotypes of human rotavirus in different populations. J Clin Microbiol . 1992;;30:781-785.
20 +
American Academy of Pediatrics Committee on Nutrition, Mauer AM, chairman, Dweck SH, Finberg L, et al.  Use of oral fluid therapy and post-treatment feeding following enteritis in children in a developed country. Pediatrics . 1985;;75: 358-361.
21 +
Snyder J.  Too many deaths from diarrhea. JAMA . 1988;;260:3329.
22 +
Feachem RG, Koblinsky MA.  Interventions for the control of diarrhoeal diseases among young children: measles immunization. Bull World Health Organ . 1983;;61:641-652.
23 +
Koster FT, Curlin GC, Aziz KMA, Haque A.  Synergistic impact of measles and diarrhoea oon nutrition and mortality in Bangladesh. Bull World Health Organ . 1981;;59:901-908.
24 +
Institute of Medicine (US) Committee on Monitoring Access to Personal Health Care Services. Access to Health Care in America . In: Millman ML, ed. Washington, DC: National Academy Press; 1993;.
25 +
Murray JL, Bernfield M.  The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan. N Engl J Med . 1988;;319:1385-1391.
26 +
St Peter RF, Newacheck PW, Halfon N.  Access to care for poor children: separate and unequal? JAMA . 1992;;267:2760-2764.
27 +
Hemming VG, Overall JC Jr, Britt MR.  Nosocomial infections in a newborn intensive-care unit: results of forty-one months of surveillance. N Engl J Med . 1976;;294:1310-1316.
28 +
Church DL, Trevenen CL, Cadrain GR, Glass RI. Fatal rotavirus infections in southern Alberta during the 1992-93 season. Presented as a poster at the 95th General Meeting of the American Society for Microbiology; May 22, 1995; Washington, DC. Abstract No. C48.
29 +
Holman RC, Stehr-Green JK, Zelasky MT.  Necrotizing enterocolitis mortality in the United States, 1979-85. Am J Public Health . 1989;;79:987-989.
30 +
Victora CG, Smith PG, Vaughan JP, et al.  Infant feeding and deaths due to diarrhea: a case-control study. Am J Epidemiol . 1989;;129:1032-1041.
31 +
Duggan C, Santosham M, Glass RI.  The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. MMWR Morb Mortal Wkly Rep . 1992;;41:1-20.
32 +
Avery ME, Snyder JD.  Oral therapy for acute diarrhea: the underused simple solution. N Engl J Med . 1990;;323:891-894.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Bern C, Martines J, de Zoysa I, Glass RI.  The magnitude of the global problem of diarrhoeal disease: a ten year update. Bull World Health Organ . 1992;;70:705-714.
2 +
Lew JF, Glass RI, Gangarosa RE, Cohen IP, Bern C, Moe CL.  Diarrheal deaths in the United States, 1979-1987: a special problem for the elderly. JAMA . 1991;;265:3280-3284.
3 +
Garthright WE, Archer DL, Kvenberg JE.  Estimates of incidence and costs of intestinal infectious diseases in the United States. Public Health Rep . 1988;;103:107-115.
4 +
Glass RI, Lew JF, Gangarosa RE, LeBaron CW, Ho MS.  Estimates of the morbidity and mortality from diarrheal diseases in American children. J Pediatr . 1991;;118:527-533.
5 +
Gangarosa RE, Glass RI, Lew JF, Boring JR.  Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol . 1992;; 135:281-290.
6 +
Ho M-S, Glass RI, Pinsky PF, et al.  Diarrheal deaths in American children: are they preventable? JAMA . 1988;;260:3281-3285.
7 +
Bern C, Lew J, McFeeley P, Ing RT, Glass RI.  Diarrheal deaths in children living in New Mexico: toward a strategy of preventive interventions. J Pediatr . 1993;;122:920-922.
8 +
Meyers A, Siegel B, Vinci R.  Economic barriers to the use of oral rehydration therapy: a case report. JAMA . 1991;;265:1724-1725.
9 +
LeBaron CW, Lew J, Glass RI, Weber JM, Ruiz-Palacios GM, the Rotavirus Study Group.  Annual rotavirus epidemic patterns in North America: results of a five-year retrospective survey of 88 centers in Canada, Mexico, and the United States. JAMA . 1990;;264:983-988.
10 +
National Center for Health Statistics, US Dept of Health and Human Services. Multiple Cause of Death for ICD-9 Data [public use data tape documentation] . Hyattsville, Md: National Center for Health Statistics; 1993;.
11 +
World Health Organization. International Classification of Diseases, Eighth Revision, Adapted for Use in the United States . Washington, DC: US Government Printing Office; 1975;:1.
12 +
World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death . Geneva, Switzerland: World Health Organization; 1977;:1.
13 +
Chamblee RF, Evans MC.  TRANSAX, the NCHS system for producing multiple cause-of-death statistics, 1968-78. Vital Health Stat 1 .1986;;No. (20) .
14 +
Israel RA, Rosenberg HM, Curtin LR.  Analytical potential for multiple cause-of-death data. Am J Epidemiol . 1986;;l24:161-179.
15 +
National Center for Health Statistics, US Dept of Health and Human Services. Public Use Data Tape Documentation, 1991, Detail Natality . Hyattsville, Md: National Center for Health Statistics; 1993;.
16 +
Bureau of the Census. 1980 Census of Population, Vol 1: Characteristics of the Population . PC80-1-B1, 1981;:91-110. Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Health Statistics; 1981. US Dept of Health and Human Services publication PHS 91-1101.
17 +
KIeinbaum DG, Kupper LL, Muller KE. Applied Regression Analysis and Other Multivariable Methods . Boston, Mass: PWS-Kent Publishing Company; 1988;.
18 +
Klein JO, Brunell PA, Cherry JD, Fulginiti VA. Report of the Committee on Infectious Diseases, Redbook . 19th ed. Evanston, Ill: American Academy of Pediatrics; 1982;.
19 +
Woods PA, Gentsch J, Gouvea V, et al.  Distribution of serotypes of human rotavirus in different populations. J Clin Microbiol . 1992;;30:781-785.
20 +
American Academy of Pediatrics Committee on Nutrition, Mauer AM, chairman, Dweck SH, Finberg L, et al.  Use of oral fluid therapy and post-treatment feeding following enteritis in children in a developed country. Pediatrics . 1985;;75: 358-361.
21 +
Snyder J.  Too many deaths from diarrhea. JAMA . 1988;;260:3329.
22 +
Feachem RG, Koblinsky MA.  Interventions for the control of diarrhoeal diseases among young children: measles immunization. Bull World Health Organ . 1983;;61:641-652.
23 +
Koster FT, Curlin GC, Aziz KMA, Haque A.  Synergistic impact of measles and diarrhoea oon nutrition and mortality in Bangladesh. Bull World Health Organ . 1981;;59:901-908.
24 +
Institute of Medicine (US) Committee on Monitoring Access to Personal Health Care Services. Access to Health Care in America . In: Millman ML, ed. Washington, DC: National Academy Press; 1993;.
25 +
Murray JL, Bernfield M.  The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan. N Engl J Med . 1988;;319:1385-1391.
26 +
St Peter RF, Newacheck PW, Halfon N.  Access to care for poor children: separate and unequal? JAMA . 1992;;267:2760-2764.
27 +
Hemming VG, Overall JC Jr, Britt MR.  Nosocomial infections in a newborn intensive-care unit: results of forty-one months of surveillance. N Engl J Med . 1976;;294:1310-1316.
28 +
Church DL, Trevenen CL, Cadrain GR, Glass RI. Fatal rotavirus infections in southern Alberta during the 1992-93 season. Presented as a poster at the 95th General Meeting of the American Society for Microbiology; May 22, 1995; Washington, DC. Abstract No. C48.
29 +
Holman RC, Stehr-Green JK, Zelasky MT.  Necrotizing enterocolitis mortality in the United States, 1979-85. Am J Public Health . 1989;;79:987-989.
30 +
Victora CG, Smith PG, Vaughan JP, et al.  Infant feeding and deaths due to diarrhea: a case-control study. Am J Epidemiol . 1989;;129:1032-1041.
31 +
Duggan C, Santosham M, Glass RI.  The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. MMWR Morb Mortal Wkly Rep . 1992;;41:1-20.
32 +
Avery ME, Snyder JD.  Oral therapy for acute diarrhea: the underused simple solution. N Engl J Med . 1990;;323:891-894.

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