Armstrong G L, Conn L A, Pinner R W
National Foundation for Infectious Diseases, Centers for Disease Control and Prevention, National Center for Infectious Diseases, Atlanta, GA, USA.
JAMA. 1999 Jan 6;281(1):61-6. doi: 10.1001/jama.281.1.61.
Recent increases in infectious disease mortality and concern about emerging infections warrant an examination of longer-term trends.
To describe trends in infectious disease mortality in the United States during the 20th century.
Descriptive study of infectious disease mortality in the United States. Deaths due to infectious diseases from 1900 to 1996 were tallied by using mortality tables. Trends in age-specific infectious disease mortality were examined by using age-specific death rates for 9 common infectious causes of death.
Persons who died in the United States between 1900 and 1996.
Crude and age-adjusted mortality rates.
Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980. From 1981 to 1995, the mortality rate increased to a peak of 63 deaths per 100000 in 1995 and declined to 59 deaths per 100000 in 1996. The decline was interrupted by a sharp spike in mortality caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was particularly rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza were responsible for the largest number of infectious disease deaths throughout the century. Tuberculosis caused almost as many deaths as pneumonia and influenza early in the century, but tuberculosis mortality dropped off sharply after 1945. Infectious disease mortality increased in the 1980s and early 1990s in persons aged 25 years and older and was mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in 25- to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza deaths among persons aged 65 years and older. There was considerable year-to-year variability in infectious disease mortality, especially for the youngest and oldest age groups.
Although most of the 20th century has been marked by declining infectious disease mortality, substantial year-to-year variation as well as recent increases emphasize the dynamic nature of infectious diseases and the need for preparedness to address them.
近期传染病死亡率上升以及对新出现感染的担忧,使得有必要审视长期趋势。
描述20世纪美国传染病死亡率的趋势。
对美国传染病死亡率的描述性研究。利用死亡率表统计了1900年至1996年因传染病导致的死亡人数。通过9种常见传染病死因的年龄别死亡率,研究了特定年龄传染病死亡率的趋势。
1900年至1996年在美国死亡的人群。
粗死亡率和年龄调整死亡率。
在20世纪的前8个十年中,传染病死亡率从1900年的每10万人797例死亡降至1980年的每10万人36例死亡。1981年至1995年,死亡率上升至1995年的每10万人63例死亡的峰值,1996年降至每10万人59例死亡。1918年流感大流行导致的死亡率急剧上升打断了下降趋势。1938年至1952年,下降尤为迅速,死亡率每年下降8.2%。肺炎和流感在整个世纪导致的传染病死亡人数最多。本世纪初,结核病导致的死亡人数几乎与肺炎和流感相当,但1945年后结核病死亡率急剧下降。20世纪80年代和90年代初,25岁及以上人群的传染病死亡率上升,主要是由于25至64岁人群中获得性免疫缺陷综合征(艾滋病)的出现,以及65岁及以上人群中肺炎和流感死亡人数的增加(程度较轻)。传染病死亡率存在相当大的逐年波动,尤其是最年轻和最年长的年龄组。
尽管20世纪大部分时间传染病死亡率呈下降趋势,但逐年的大幅波动以及近期的上升凸显了传染病的动态性质以及应对传染病的准备工作的必要性。