CENTER FOR
HEALTH
STATISTICS
MINNESOTA VITALSIG S
MINNESOTA DEPARTMENT
OF HEALTH
May 2005 Vol. 1, No. 2
Trends in Mortality, 1990 – 2003
This report will review trends in mortality among Minnesota residents. The first section will provide an
historical overview of numbers, rates, and general demographic information. The second section will look
at leading causes of death as well as trends in intentional vs. unintentional injuries. The final section will
provide information on trends in place of death, autopsies performed, and method of disposition.
Historical Overview
In 1910 there were 22,868 deaths in Minnesota (Figure 1). As the population of the state increased, so has
the number of deaths. Except for the spike in 1918, due to the influenza epidemic, this increase has been
fairly steady. However, the crude death rate, the number of deaths in a specific population per 100,000
population, has decreased from 1,101.7 in 1910 to 743.2 in 2003.
Figure 1: Number of Deaths and Crude Death Rates
1910 - 2003
45,000
1600.0
40,000
1400.0
1200.0
30,000
1000.0
25,000
800.0
20,000
600.0
15,000
Number of Deaths
10,000
400.0
Crude Death Rate per 100,000
200.0
5,000
0
0.0
00
20
90
19
80
19
70
19
60
19
50
19
40
19
30
19
20
19
10
19
May 2005
Rate per
100,000
Population
Number of Deaths
35,000
1
Demographics
Age at Death
In 1944, the majority of deaths (63.1%) occurred in the 55-84 year old population; in 2003 the majority
(72.2%) of deaths occurred in the 65-94 year age group, a ten year shift in age group (Figure 2). A large
portion of this shift can be attributed to the increase in deaths occurring to the 85-94 year olds. In 1944,
8.9% of deaths were to those ages 85-94; in 2003 this percent was 29.1%. In addition, the median age at
death has also increased from 1944 to 2003. In 1944, the median age at death was 67.4 years and in 2003
it was 79.5 years.
Figure 2: Percent of Deaths by Age,
Minnesota 1944 and 2004
35.0
30.0
Percent
25.0
20.0
15.0
10.0
5.0
0.0
Under 1-4
1
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+
1944
2003
Table 1 demonstrates the variation of crude death rates by age. The 0-4 year age group has a higher death
rate than the other young age categories because the risk of death is much higher for infants under 1 year
of age. Between 5 and 34 years of age the rate remains below 100 deaths per 100,000. After age 35 the
rates increase steadily with 85+ age group’s rate being three times higher than that of the 75-84 year olds.
Table 1: Crude Death Rates per 100,000 by Age Group,
Minnesota 1990, 1997 and 2003
Age Group
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
May 2005
1990
169.9
16.8
79.0
79.9
151.8
336.2
953.4
2,354.0
5,480.9
14,787.4
1997
145.1
17.7
57.7
71.2
130.6
301.3
853.8
2,185.0
5,343.6
15,328.1
2003
119.9
15.2
69.2
70.7
135.5
299.7
699.1
1,898.2
4,845.1
13,995.8
2
Age and Gender
When comparing death rates by age and gender in Minnesota in 1990, 1997 and 2003 males consistently
had higher rates of death than females (Table 2). In the 15-24 year old age range, the male rate was two to
three times higher than the female rate.
Table 2: Crude Death Rates per 100,000 Population by Gender,
Minnesota 1990, 1997 and 2003
1990
Female
Male
147.7
191.3
13.0
20.3
40.4
117.0
41.4
118.3
103.7
199.4
263.2
410.1
710.9
1,210.1
1,725.8
3,123.3
4,294.5
7,410.5
13,623.7 17,741.3
Age Group
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
1997
Female
Male
135.3
154.4
14.7
20.6
37.4
77.3
45.2
97.0
88.3
171.9
227.8
375.5
659.4
1,056.0
1,638.7
2,828.1
4,319.7
6,894.0
14,169.9 18,303.6
2003
Female
Male
98.8
140.1
10.6
19.5
35.4
101.5
44.7
95.8
104.0
166.4
221.7
376.9
545.6
857.5
1,540.6
2,307.8
4,029.8
6,029.5
13,207.2 15,825.8
Males die at younger ages than females. Figure 5 shows the age at death in 2003 by gender. The number
of deaths for females peaks at a later age than for males.
Number of Deaths
Figure 5: Number of Deaths by Age
Minnesota, 2003
900
800
700
600
500
400
300
200
100
0
Under
1
Male
Female
10
20
30
40
50
60
70
80
90
100
110
Age in Years
May 2005
3
Age-Adjusted Death Rates
While age-specific crude death rates provide an estimate of death in a population, they may not be the best
indicator of mortality because of age differences within populations. Age-adjusted mortality rates provide
unbiased comparisons that are not influenced by differences in age distribution in populations. The ageadjusted death rate for Minnesotans has decreased slightly. In 1990, the age-adjusted death rate was 819.7
per 100,000 population, by 2003 it had decreased to 712.8. When comparing age-adjusted death rates by
gender, the female rate has remained consistently below the male rate since 1990 (Figure 4). In 1990, the
male age-adjusted death rate was 1,055.4 per 100,000 males while the female rate was much lower at
655.5 per 100,000 females. By 2003, the rate for males had dropped to 860.5 and the female rate to 601.0.
Figure 4: Age-Adjusted Death Rate* per 100,000 by Year and
Gender, Minnesota 1990-2003
Rate per 100,000 Population
1200
1000
800
600
Male
400
Female
Total
200
2
1
3
20
0
20
0
0
20
0
8
7
6
9
20
0
19
9
19
9
19
9
4
3
2
1
5
19
9
19
9
19
9
19
9
19
9
19
9
19
9
0
0
*Adjusted to the 2000 US standard population
Race and Ethnicity
Crude death rates vary by race and ethnicity in Minnesota with Whites having the highest crude death rate
for 1999-2003 at 804.1 deaths per 100,000. However, when comparing racial and ethnic groups using
age-adjusted death rates, a different picture is presented. American Indians have the highest age-adjusted
death rate among racial/ethnic groups at 1,186.6 followed by African Americans at 959.3 (Table 3).
Table 3: 1999-2003 Minnesota Deaths by Race
Race
White
African American
American Indian
Asian
Hispanic3
Number
182,323
3,649
1,799
1,570
1,369
Crude Death
Rate1
804.1
374.7
575.3
196.5
196.4
Age Adjusted
Death Rate2
740.8
959.3
1,186.6
543.6
571.1
1
the number of deaths in a specific population per 100,000 persons in
that specific population
2
per 100,000 US 2000 standard population
3
may be of any race
May 2005
4
Table 4: Selected Mortality Statistics: Minnesota 1970, 1980 and 1990-2003
Age-Adjusted Death Rate**
Year
Number
of Deaths
Crude Death Rate*
Total
Male
Female
1970
33,919
891.4
N/A
N/A
N/A
1980
33,415
819.8
N/A
N/A
N/A
1990
34,736
791.8
819.7
1,055.4
655.5
1991
35,240
795.7
818.4
1,065.1
649.5
1992
34,979
781.7
801.2
1,023.8
644.5
1993
36,405
804.4
819.3
1,048.0
660.1
1994
36,342
794.8
805.5
1,026.9
651.4
1995
37,426
811
819.7
1,028.0
670.0
1996
37,164
797.9
803.9
1,012.2
656.7
1997
36,878
787.1
788.2
988.0
647.1
1998
37,152
786.2
775.4
947.2
649.1
1999
38,472
805.6
790.8
967.2
660.1
2000
37,595
764.2
758.7
927.8
636.9
2001
37,505
752.4
740.1
903.2
619.3
2002
38,437
765.7
745.9
903.0
628.8
2003
37,603
743.2
712.8
860.5
601.0
*Per 100,000 per population
**Adjusted to the 2000 US standard population
May 2005
5
Causes of Death
Table 5: Leading Causes of Death for Selected Years, Minnesota
Rank
1910
(ICD-2)
1935
(ICD-4)
1950
(ICD-6)
1975
(ICD-8)
2003
(ICD-10)
1
Pneumonia
Heart Disease
Heart Disease
Heart Disease
Cancer
2
Diarrheal Dis.
Children
Cancer
Cancer
Cancer
Heart Disease
3
Tuberculosis
Cerebral
Hemorrhage
Vascular
Lesions
Stroke
Stroke
4
Accidental
Deaths
Accidental
Deaths
Accidental
Deaths
Accidental
Deaths
Unintentional
Injury
Chronic Lower
Respiratory
Disease
Congenital
Pneumonia and
Pneumonia and
Malformations
Influenza
Influenza
5
Cancer
ICD: International Classification of Disease, number indicates ICD version
In the early 20th century, infectious diseases were the leading causes of death in Minnesota and the nation
(Table 5). Improvements in public health programs and nutrition in the early 20th century and the
introduction of antibiotics mid-century dramatically reduced the prevalence of infectious diseases among
the leading causes of deaths. By mid-century heart disease, cancer, and stroke were the leading causes of
death in Minnesota. This has remained relatively unchanged into the 21st century. However, for the first
time in over fifty years, cancer has emerged as the leading cause of death in Minnesota with a rate of
181.5 in 2003 overtaking heart disease at 161.4 (Figure 6).
Figure 6: Crude Death Rates per 100,000
Heart Disease and Cancer
Minnesota, 1950-2003
Rate per 100,000 Population
400.0
350.0
300.0
250.0
200.0
150.0
Heart Disease
100.0
Cancer
50.0
May 2005
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
1950
0.0
6
Table 6: Crude Death Rates* by Leading Causes of Death:
Minnesota 1970, 1980 and 1990-2003
All Injuries**
Unintentional Injury
Motor Vehicle
Falls
113.6
56.1
27.8
10.5
170.9
79.4
44.3
22.1
7.5
245.9
185.4
64.9
33.4
15.1
7.9
1991
241.0
189.6
64.6
33.0
13.3
8.1
1992
228.8
190.9
62.8
33.0
14.1
8.2
1993
232.9
186.2
67.2
33.5
13.3
8.9
1994
224.1
186.9
63.4
35.2
15.6
10.0
1995
223.8
187.4
67.5
35.8
14.2
10.1
1996
214.0
188.9
64.7
34.9
13.5
11.2
1997
203.0
186.4
63.5
36.8
12.6
11.4
1998
198.3
186.0
60.4
36.8
14.3
10.9
1999
199.5
185.9
62.5
36.9
13.3
8.4
2000
179.8
187.0
56.4
35.2
13.7
7.9
2001
176.5
181.0
55.0
35.5
12.2
9.6
2002
171.0
183.4
53.7
38.0
14.4
10.5
13.9
10.6
Heart Disease
Cancer
Stroke
1970
335.4
161.6
1980
309.0
1990
Year
2003
161.4
181.5
50.4
37.6
*Per 100,000 per population
**All injuries includes motor vehicle crashes, falls, and other accidents
May 2005
7
Injury Deaths
Unintentional injuries have long been the number one cause of death to children, teens, and adults under
age 35. Until age 65, unintentional injuries remain one of the top five causes of death and also appear in
the top five for the overall population. Furthermore, males account for many more unintentional injury
deaths than do females. This same dichotomy between males and females appears in the intentional injury
deaths (suicide and homicide).
Figure 7: Percent of Unintentional Injury, Suicide and Homicide Deaths by Gender,
Minnesota 1950-2003
Unintentional Injury Deaths,
1950-2003 Cumulative
Suicide Deaths, 1950-2003
Cumulative
Female
21%
Female
33%
M ale
67%
Homicide Deaths, 1950-2003
Cumulative
Female
33%
M ale
79%
M ale
67%
Unintentional injury deaths fall mainly into two categories. Over the last 50 years, motor vehicle crashes
have been responsible for 55% of unintentional deaths to persons under age 65, while falls were the cause
of 60% of unintentional injury deaths to those aged 75 and over. For those in the 65 to 74 age group, falls
and motor vehicle crashes each accounted for approximately the same number of deaths.
May 2005
8
Table 7: Homicide, Suicide and Unintentional Injury Rates* by Gender
Minnesota 1970, 1980 and 1990-2003
Suicide
Homicide
Female
Unintentional Injury
Male
Female
Year
Male
Female
Male
1970
15.7
4.7
3.3
1.2
77.6
35.4
1980
17.1
4.7
3.8
2.1
61.7
27.6
1990
20.0
5.0
4.5
1.7
44.0
23.3
1991
19.2
3.9
4.4
1.8
42.4
23.9
1992
18.9
4.2
4.2
2.1
40.8
25.4
1993
17.8
4.5
4.4
1.9
42.2
25.2
1994
17.8
3.8
4.9
1.7
42.2
28.5
1995
18.9
3.7
5.4
2.2
43.5
28.4
1996
17.3
3.8
5.0
2.5
43.3
26.9
1997
15.1
3.0
4.5
1.1
44.6
29.3
1998
16.5
3.3
3.7
1.5
44.2
29.7
1999
15.6
3.0
4.0
1.8
43.3
30.7
2000
15.1
2.9
3.7
2.1
42.2
28.3
2001
15.8
3.4
3.3
1.7
43.3
27.9
2002
16.4
3.5
3.8
1.4
45.6
30.6
2003
16.1
3.6
4.1
1.1
44.7
30.6
*Per 100,000 per specific population
Autopsies, Place of Death and Disposition
Autopsies
Minnesota’s autopsy rate reflects the national decline in the percent of deaths that are autopsied. While the
percent of autopsies performed for injury deaths has increased since 1955, the percent for natural deaths
has fallen since 1965, from a high of 25.5% to the current 5.0% in 2003 (Figure 8). Concerns have been
raised by the medical community about this decline as potentially valuable information on the etiology of
diseases is being lost and may have negative consequences on the diagnosis and treatment of illnesses.
May 2005
9
60.0
Figure 8: Percent of Deaths with Autopsy Performed
Minnesota, 1955-2003
Percent
50.0
40.0
Natural Deaths
30.0
Injury Deaths*
20.0
All Deaths
10.0
2003
2000
1995
1990
1985
1980
1975
1970
1965
1960
1955
0.0
*Injury Deaths include unintentional injury, suicide, and homicide.
Place of Death
100.0
80.0
Percent
60.0
40.0
20.0
0.0
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2001
2002
2003
Since 1950, more deaths have occurred in
licensed facilities such as hospitals and
nursing homes than in other locations. After
a 26% rise between 1965 and 1970 in the
percent of deaths occurring in a facility vs.
another location, there was a slower increase
throughout the 70’s and 80’s, followed by a
slow decline throughout the 90’s that
continues through the present.
Figure 9: Place of Death
Minnesota, 1950-2003
Licensed Facility
Other Location
Disposition
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Percent
The percent of deaths to Minnesota residents for which cremation was the method of disposition has
steadily increased since 1989, the first year for which data is available. In 1989 only 14.5% of deaths were
cremations while in 2003 cremation
was chosen for 34.6% of deaths with
Figure 10: Method of Disposition
a corresponding decrease in the
Minnesota, 1989-2003
percentage of burials from 82.2% to
100.0
63.1%. For the remaining 2.3% other
80.0
methods of disposition such as
60.0
entombment or donation were
40.0
indicated, or the method was not
reported on the certificate. The
20.0
number of donations to medical
0.0
schools, while still less than 1% of
deaths, has increased from 0.2% of
Burial
deaths to 0.7%.
Cremation
May 2005
10
Table 8: Autopsies, Place of Death, and Disposition, Selected Years Minnesota
Autopsies Performed
by Type of Death, %
Place of Death, %
Method of Disposition, %
Natural
Injury*
Year
Licensed
Facility
Other
Location
Year
Burial
Cremation
1955
21.0
24.9
1950
56.9
43.1
1989
82.2
14.5
1960
23.3
32.3
1955
62.4
37.6
1990
81.6
15.6
1965
25.5
40.6
1960
58.4
41.6
1991
80.6
17.0
1970
23.6
43.6
1965
57.1
42.9
1992
79.7
18.4
1975
19.6
43.9
1970
77.1
22.9
1993
78.8
19.2
1980
15.7
43.7
1975
77.1
22.9
1994
74.8
20.4
1985
11.6
44.4
1980
80.7
19.3
1995
73.7
21.6
1990
9.3
45.8
1985
81.0
19.0
1996
72.9
23.4
1995
6.2
45.4
1990
80.2
19.8
1997
74.5
22.2
2000
5.3
48.2
1995
75.9
24.1
1998
70.5
25.8
2003
5.0
48.5
2000
74.2
25.8
1999
68.8
27.7
2001
73.7
26.3
2000
67.1
29.8
2002
72.7
27.3
2001
64.9
31.9
2003
71.0
29.0
2002
65.0
32.8
2003
63.1
34.6
*Injury Deaths include unintentional injury, suicide, and homicide.
May 2005
11
Minnesota Vital Signs
Minnesota Center for Health Statistics
Office Health Policy, Statistics and Informatics
Minnesota Department of Health
Vital Signs is available on the Minnesota Center for Health Statistics website,
www.health.state.mn.us/divs/chs/vitalsigns/index.html.
Definitions of vital statistics terms and formulas can be found in Vital Signs, Introduction to
Vital Statistics, March 2005 www.health.state.mn.us/divs/chs/vitalsigns/index.html
If you require this document in another format such as large print, Braille, or cassette tape call
651/296-1232 or email [email protected].
Protecting, maintaining and improving the health of all Minnesotans