Increased HIV/AIDS Mortality Among Residents Aged 25-44 Years -- Baltimore, Maryland, 1987-1989

From 1987 through 1989, overall mortality among Baltimore residents aged 25-44 years increased from 380.7 deaths per 100,000 residents to 452.6 deaths per 100,000, reflecting the substantial impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). To better characterize this increase in mortality, the Baltimore City Health Department analyzed information on death certificates from the Baltimore City Bureau of Vital Statistics for persons aged 25-44 years for 1987- 1989. This report summarizes the analysis and characterizes HIV-infection/AIDS-related deaths among residents of Baltimore in this age group.

Of the five leading causes of death in Baltimore, the increase was greatest for HIV infection/AIDS (International Classification of Diseases, Ninth Revision [ICD-9], codes 042-044); the rate for persons aged 25-44 years more than doubled (Table 1). In 1989, mortality attributable to HIV infection/AIDS was more than three times the national rate; the impact was greatest among black* men, accounting for 15.5% of all deaths in this group.

From 1987 through 1989, HIV-infection/AIDS-related deaths among black men more than doubled (Table 1). In 1987, HIV infection/AIDS was the third leading cause of death for this group (64.6 deaths per 100,000; n=40) but by 1988, had become the leading cause of death (114.9; n=73). In 1989, the death rate for this group increased to 137.1 (n=90). HIV-infection/AIDS-related mortality among white men also increased: among this group, HIV-infection/AIDS-related mortality was the sixth leading cause of death in 1987 (19.9; n=9), but had become the leading cause of death in 1989 (65.3; n=29).

In 1988, HIV infection/AIDS was the third leading cause of death (22.6 deaths per 100,000; n=17) for black women (Table 1); by 1989, HIV infection/AIDS had become the second leading cause of death (34.9; n=27), surpassed only by heart disease.

Reported by: TL McArdell, JJ Sweitzer, MS, JN Lewis, MD, A Cohen, JD, Preventive Medicine and Epidemiology, Baltimore City Health Dept. Div of HIV/AIDS, National Center for Infectious Diseases; Div of Sexually Transmitted Diseases and HIV Prevention and Office of the Director, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The high HIV-infection/AIDS-related death rate for persons aged 25-44 years in Baltimore reflects the increasing burden of disease associated with HIV infection/AIDS in certain U.S. metropolitan areas. In San Francisco, Los Angeles, New York City, and Baltimore, HIV infection/AIDS has become the leading cause of death among young adult men, surpassing heart disease, cancer, and homicide (1).

In 1989, HIV infection/AIDS was the second leading cause of death for men and the sixth leading cause of death for women aged 25-44 years in the United States (2). In comparison, in 1989 in Baltimore, HIV-infection/AIDS-related mortality among persons aged 25-44 years was more than twice the national average for white men and three times the national average for black men. The increase of HIV-infection/AIDS-related mortality among blacks reflects the disproportionate representation of minorities in urban communities with a high incidence of HIV infection. The findings in this report also are consistent with national trends that indicate HIV infection/AIDS is becoming a leading cause of death among young women. For example, in New York City, HIV infection/AIDS is now the leading cause of death among women aged 25-44 years (3).

In Baltimore and other metropolitan areas, the reduction of new HIV infections will require the cooperative efforts of public and private organizations in providing 1) public information about HIV infection/AIDS; 2) HIV health education and risk-reduction initiatives; 3) HIV counseling, testing, referral, and partner-notification services; and 4) HIV early intervention services. For example, the Baltimore community used the HIV-infection/AIDS-related mortality data at city health conferences and seminars to train health professionals to work with subpopulations within the metropolitan area through the development of 1) a "grass roots" HIV-infection prevention campaign for persons with high-risk behaviors and 2) a needle clean-up program within neighborhoods with high levels of HIV infection.

References

1. CDC. Mortality attributable to HIV infection/AIDS -- United States, 1981-1990. MMWR 1991;40:41-4.

2. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).

3. New York City Department of Health. AIDS surveillance update.

• Numbers for racial/ethnic groups other than white and black were too small (less than 2% of the population) for use in this analysis.

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