Popular Science Monthly/Volume 82/April 1913/The Increasing Mortality from Degenerative Maladies

by E. E. Rittenhouse

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THE INCREASING MORTALITY FROM DEGENERATIVE MALADIES

By E. E. RITTENHOUSE

CONSERVATION COMMISSIONER, THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES

IT is quite generally believed by those who have studied American morbidity and mortality tendencies that there has been a marked increase in recent years in the death rate from chronic diseases of the important and hardest worked organs of the body. They also believe that this increase is reflected in the upward trend of the general mortality rate in middle life and old age. There are those, however, who assert—obviously without investigation or analysis of the public statistics bearing upon the subject—that neither of these increases has taken place.

And there are still others, some of them prominent in the health movement, who express the opinion—also apparently without reference to the records—that the increase is natural and to be expected. Their theory is that the increase, whatever it may be, is due to the saving of lives in the younger ages, chiefly from communicable disease; that these lives passing into the older periods—many of them with weakened power of resistance—have given us more old people to die than we formerly had.

Such an increase in the number living in the later ages would merely lead to a correspondingly increased number of deaths, and not to an increase in the death rate at these ages, which is the ratio between the number dying and the number living.

The areas where the most dependable vital statistics are to be had, show but a trifling increase in the group above age 40 in each 1,000 of the population, while the death rate in the same group shows a very marked increase.

While the mortality experts of a number of the more important life insurance companies have recognized the increasing mortality in the older ages, and in some instances increased the severity of medical examinations, and in others increased premiums at those ages, only one of the larger companies and one of the smaller ones have given especial attention to the excessive life waste in these ages in their health conservation work.

 

Mortality Statistics

Much progress has been made in recent years in popularizing our vital statistics, but still much valuable information which should be placed before the public in concise and popular form lies buried in our official records and in the files of our statisticians and scientists who have analyzed them for their own or scientific use.

Owing to the incompleteness of mortality statistics, especially in former years, it is frequently necessary in making comparisons to insert personal estimates to fill gaps. The rates in such instances are, therefore, deduced partly from statistics and partly from personal judgment.

The statistics used in arriving at the comparisons given below were, however, sufficiently complete to render unnecessary the interpolation of estimates to fill omissions, with one unimportant exception.^[1] The rates deduced are the direct product of existing official reports, which are accessible to any one desiring to look them up.

The purpose of submitting these ratios is not primarily to fix a specific rate of increase, but to indicate the trend of mortality in middle life and old age in the area named. Those interested in the subject will judge the measure of the actual increase by the value they may place upon the original data from which these rates are extracted.

 

Degenerative Diseases

That the ratio of deaths from the more important degenerative affections has increased sharply in recent years is so generally known that it is needless to present in this brief paper the indicated advance

Degenerative Diseases

Massachusetts 1880-1909^[2] Increase in the Death Bate (per 10,000 Population) by Age Periods

Ages			1880		1909		Increase		Per Cent of Same
All			23	.21	43	.26	20	.05	86	.38
Under 5			7	.92	10	.36	2	.44	30	8
		5-9	2	.91	3	.95	1	.04	35	.7
		10-14	2	.85	4	.72	1	.87	65	.6
		15-19	3	.10	5	.43	2	.33	72	.3
		20-29	4	.95	8	.09	3	.14	63	.4
		30-39	10	.13	18	.79	8	.66	85	.5
		40-49	19	.70	37	.84	18	.14	92	.1
		50-59	39	.01	91	.30	52	.29	134
		60-69	102	.05	212	.93	110	.88	108	.7
		70 and over	261	.1	558	.2	297	.1	113

in the rate for each disease separately. They are, therefore, grouped by age divisions. By this method the disturbing effect on the rates of any changes in classification or improvement in diagnosis is largely overcome. The most reliable records available for this purpose, giving age divisions in 1880, are those of Massachusetts. While the death rates in childhood and early adult life are relatively small, they too show a significant increase.

Included in this group are apoplexy, paralysis and diseases of the heart, circulatory system, kidneys and liver.^[3]

The most important of the other diseases of middle life and old age that has increased is cancer. Comparing 1910 with 1880, the cancer death rate has increased in Massachusetts 66 per cent.; since 1900 it has increased 31 per cent. External cancer alone has increased in the entire registration area 55 per cent, since 1900.^[4]

In 16 cities the mortality rate from organic heart, apoplexy and kidney affections alone has increased in 30 years from 17.94 to 34.78, or 94 per cent.; during 10 years (1900-1910) it increased from 29.4 to 34.78, or 18 per cent. In New Jersey, 1880-1910, it increased from 16.5 to 34.3, or 108 per cent.

The curves vary in different states and cities, but the same general trend is observed wherever statistics relating to these causes of death are available.

 

General Death Rate—Older Age Groups

In 1880 the comparisons are confined to Massachusetts and New Jersey, and to 16 registration cities, because in these areas we have the most reliable statistics^[5] of that time, from which these comparisons can be carried through to 1910. Both of these were normal mortality years,^[6] and, it is believed, represent a fair average of the preceding five-year periods.

That this upward tendency has continued is indicated by a comparison of ten registration states^[7] 1900-1910. Increases: ages 45-49,

Sixteen^[8] Registration Cities. 1880-1910

Decrease and Increase in General Death Rate (per 1,000 Population) by Age Periods

Ages	D.R. 1880		D.R. 1910		Dec. and Inc. in Rate		Per Cent, of Same
All	22	.09	16	.36	-5	.73	-26
Under 35	21	.4	11	.36	-10	.04	-47
35-44	13	.6	12	.99	-1	.31	-9	.6
45-54	18	.3	22	.07	+3	.77	+20	.6
55-64	29	.3	37	.54	+8	.24	+28	.1
65 and over and unknown	80	.3	89	.30	+9		+11	.2
Above 45	32		40	.10	+8	.10	+25	.31
Above 55	48	.44	58	.82	+10	.38	+21	.43

.61, or 4.5 per cent.; ages 50-54, 1.16, or 6.7 per cent.; ages 55-59 (decrease), .13, or .5 per cent.; ages 60-64 (increase), 1.48, or 4.6 per cent.; ages 65-69, 3.23, or 6.75 per cent.; ages 70-74, 3.45, or 4.9 per cent.; age 75 and over, .82, or .6 per cent.

Massachusetts and New Jersey. 1880-1910

Decrease and Increase in General Death, Rate (per 1,000 Population) by Age Periods

Ages	D.R. 1880		D.R. 1910		Dec. and Inc. in Rate		Per Cent, of Same
All	17	.63	15	.80	-1	.83	-10	.38
Under 30	16.	.3	11	.3	-5	.0	-30	.6
30-34	9	.12	6	.99	-2	.13	-23	.3
35-39	10	.1	8	.90	-1	.20	-11	.8
40-44	10	.20	10	.95	+	.75	+7	.35
45-49	12	.20	13	.79	+1	.59	+13	.0
50-54	13	.70	18	.35	+4	.65	+33	9
55-59	20	.49	24	.28	+3	.79	+18	5
60-64	25	.69	34	.85	+9	.16	+35	.6
65-69	40	.5	53	.16	+12	.66	+31	2
70-74	55	.4	75	.96	+20	.56	37	.1
75 and over	123	.68	143	.66	+19	.98	+16	.1
Above 40	25	.10	30	.42	+5	.32	+21	.20
Above 50	35	.24	44	.07	+8	.83	+25	.06
Above 60	53	.81	67	.73	+13	.92	+25	.87

To summarize, the public records under consideration indicate that:

1. The mortality rate from apoplexy, paralysis, diseases of the heart, circulatory system, kidneys and liver has heavily increased in the younger as well as in the older groups. The total deaths were 367,700 in 1910.

2. In Massachusetts the death rate from these causes has increased 86.4 per cent, in 30 years.

3. In 16 important cities the death rate from organic diseases of the heart, and from apoplexy, Bright's and nephritis has alone increased 94 per cent, in 30 years.

4. In Massachusetts the death rate from cancer has increased 66 per cent, in 30 years, and 31 per cent, during the past 10 years.

5. In the entire registration area the death rate from external cancer alone has increased 55 per cent, in 10 years, from 1900 to 1910.

6. The increase in mortality from diseases of middle life and old age is reflected in the general death rate by an increase commencing in Massachusetts and New Jersey in age group 40-44; in 16 cities group 45-54.

7. The death rate of the total population age 40 and over has increased, 1910 over 1880:

In Massachusetts and New Jersey, 30 years	5.3, or 21.2 per cent.
In sixteen cities, 30 years	8.1, or 25.3 per cent.
In ten states, 10 years (1900-10)	.89, or 3 per cent.

The increase in the proportion of older lives in our population has been very slight and could not account for the increase in the death rate.

To what extent are these adverse mortality tendencies reflected in our total population? In estimating the probable increase in the entire country, many factors must be considered, the discussion of which would consume many pages.

The rate of increase in Massachusetts and New Jersey (21 per cent.) doubtless approximates that of all of the populous states of the east. This rate would, however, be reduced if merged with the rate of increase for the agricultural population of the western and northwestern states. On the other hand, this reduction would be largely, if not totally, neutralized by the heavy urban and rural mortality in the south.

It would seem an entirely reasonable conclusion that while the average length of life has advanced, the extreme span of life has not done so—in fact, the indications are that it has been shortened.

Our failure to adapt ourselves to the extraordinary changes and strains of modern existence is commonly accepted as the cause for this excessive mortality in the later age periods. Even though the statistics indicated no increase, the urgent need for correcting our living habits would still exist.

We may agree that in the long run the trend of humanity is ever upward, and that this is but a temporary reaction, but can we afford to rest wholly upon the hope that race deterioration will automatically cease when our people have had time to adjust themselves to modern conditions? "Wise men doubt it. This problem will not solve itself; this adverse tendency will be checked only when our people are made to see conditions as they actually exist, and are aroused to the need of correcting them.

1. In the absence of the official figures of the age divisions of the population for 1910, the ratios of distribution of 1900 were used. Inasmuch as the change in the percentage of living at the different age periods is very slight in one decade, the actual ratios for 1910 will make no appreciable change in the mortality rates here given.
2. Massachusetts State Registration Reports.
3. The estimated deaths in 1910 from these diseases in the United States (based upon the Beg. area) were 367,700.
4. U. S. Mortality Statistics, 1900, Census Bulletin 109, 1910.
5. "The state and municipal registration records were copied and are used in the tabulations instead of the enumerators' schedules. These state and municipal registration records are based on a system of burial permits, and are therefore, probably very nearly accurate. This fact should be borne in mind in comparing the reported mortality of these with that of other localities." (U. S. Census Report, 1880.)
6. "The census year 1879-80 was probably a fair average year as regards mortality. No great epidemic occurred during this period, unless we may consider a marked prevalence of diphtheria as such." (U. S. Census Report, 1880.)
7. Registration states in 1900 were: Massachusetts, New Jersey, Connecticut, Maine, Michigan, New York, New Hampshire, Rhode Island, Vermont, District of Columbia and Indiana. Indiana is omitted in comparisons owing to lack of uniformity in age distribution records.
8. Sixteen cities: New York, Chicago, Philadelphia, Brooklyn, St. Louis, Baltimore, San Francisco, Cincinnati, Cleveland, New Orleans, Pittsburgh, Washington, Milwaukee, Louisville, Providence, Indianapolis.