Missouri Resident Leading Causes of Death Profile

Leading Causes of Death

Heart Disease

Resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as heart disease.

This category of "heart disease" is one of the National Center for Health Statistics' standard categories for ranking the leading causes of death. Major subcategories of Heart disease include congestive heart failure and ischemic heart disease, which includes acute myocardial infarction (“heart attack”). Other kinds of heart disease include rheumatic heart disease, hypertensive heart disease, pulmonary embolism, various valve disorders, cardiomyopathy, and atrial fibrillation.

International Classification of Diseases (ICD-10) codes: I00-I09.9, I11-I11.9, I13-I13.9, and I20-I51.9.

Cancer (Malignant Neoplasms)

Resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as a malignant neoplasm (cancer). This includes leukemia and cancers of various organs, but excludes benign neoplasms, carcinoma in situ and neoplasms of uncertain behavior.

International Classification of Diseases (ICD-10) codes C00-C97.

Lung Cancer

Resident deaths for which the underlying cause of death was given on the death certificate as malignant neoplasm (cancer) of the trachea, bronchus, and/or lung.

This set of criteria is from the National Center for Health Statistics. Counts in the Chronic Disease Comparisons Profile use a definition from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program; their criteria omit cancer of the trachea (C33).

International Classification of Diseases (ICD-10) codes C33-C34.9.

Breast Cancer

Resident deaths for which the underlying cause of death was given on the death certificate as breast cancer. This includes deaths to both male and female residents. Rates based on females alone are available from the Women's Health Profile and the Death MICA.

International Classification of Diseases (ICD-10) codes: C50-C50.9.

Colorectal Cancer

Resident deaths for which the underlying cause of death was given on the death certificate as a malignant neoplasm (cancer) of the colon, rectum, or anus.

International Classification of Diseases (ICD-10) codes: C18 - C21.8. This grouping is used by the National Center for Health Statistics and is the same as the “Malignant neoplasm of colon/rectum/anus” subcategory under Cancer in the Death MICA.

A similar but slightly different category used by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program is Colon and Rectum Cancer,” which can be found in the Chronic Disease Comparisons Profile. The differences are that this NCHS definition includes cancers of the anus but does not include those of the “intestinal tract, part unspecified.” The two differences approximately offset each other in statewide data, but for counties and cities, the difference can be in either direction.

Chronic Lower Respiratory Disease

Resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as chronic obstructive pulmonary disease and allied conditions.

Included are: bronchitis (unless it is specified as acute bronchitis), emphysema, asthma, bronchiectasis, and chronic airway obstruction not elsewhere classified. The vast majority of the deaths in this category are attributed to "Chronic airway obstruction not elsewhere classified."

International Classification of Diseases (ICD-10) codes J40-J47.

Stroke/Other Cerebrovascular Disease

Resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as cerebrovascular disease (stroke), whether due to bleeding or to blockage of arteries in the brain. Also includes deaths due to late effects of strokes.

International Classification of Diseases (ICD-10) codes I60-I69.8.

Unintentional Injury

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as unintentional injury or poisoning. For Missouri residents, accidental poisonings (mostly due to drugs) are the most common cause of unintentional injury death, followed by motor vehicle crashes and falls.

Injuries and poisonings not included are those due to medical complications, those classified as homicide or suicide, those due to war, and those for which the intent it is undetermined whether the injury was accidentally or purposely inflicted.

International Classification of Diseases (ICD-10) codes V01-X59.9, Y85-Y86.9.

Accidental Poisoning

Resident deaths for which the underlying cause of death was given on the death certificate as accidental poisoning. This is the same as the “Accidental poisoning and exposure to noxious substances” subcategory under “Accidents (unintentional injuries)” in the Death MICA. This category includes not only drugs and alcohol but also carbon monoxide and other toxic substances.
International Classification of Diseases (ICD-10) codes X40 – X49.9

Motor Vehicle Accidents

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as any accident involving one or more motor vehicles.
The number of deaths attributed to "Motor Vehicle Traffic" on the Unintentional Injury Profile is slightly smaller than this number because it includes only those accidents which took place on a public street or highway.

International Classification of Diseases (ICD-10) codes: V02 -V04.9, V09.0, V09.2, V12 -V14.9, V19.0-V19.2, V19.4-V19.6, V20 -V79.9, V80.3-V80.5, V81.0-V81.1, V82.0-V82.1, V83 -V86.9, V87.0-V87.8, V88.0-V88.8, V89.0, V89.2.

Alzheimer's Disease

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as Alzheimer's disease.

International Classification of Diseases (ICD-10) code G30-G30.9.

Diabetes Mellitus

Resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as diabetes, whether Type I, Type II or unspecified.

International Classification of Diseases (ICD-10) codes E10-E14.9.

Pneumonia and Influenza

Resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as pneumonia or influenza. This includes viral and bacterial pneumonia, bronchopneumonia, and influenza with or without pneumonia or other respiratory manifestations.

Pneumonia and influenza are grouped together because of the difficulty of separating them. For example, some cases of influenza lead to pneumonia and are attributed to the pneumonia when the underlying cause is really influenza.

Caution: These counts and rates are not comparable to those prior to 1999. The transition from ICD-9 to ICD-10 effective January 1, 1999 involved changes in the rules for selecting the single underlying cause of death for persons who died of multiple causes. The pneumonia and influenza category is one of the causes most seriously affected by the change. Nationally, the number of deaths attributed to this cause under the new system was estimated to be about 70 percent of the number which would have been attributed to it prior to the change in classification.

International Classification of Diseases (ICD-10) codes J09-J18.9.

Kidney Disease (Nephritis and Nephrosis )

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as nephritis, nephrosis, or nephrotic syndrome. Most of the deaths in this category are attributed to chronic renal failure, or to renal failure, unspecified whether chronic or acute.

International Classification of Diseases (ICD-10) codes N00-N07.9, N17-N19, and N25-N27.9.

Suicide

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as suicide or intentional self-inflicted injury. Delayed effects of self-inflicted injury are also included.

International Classification of Diseases (ICD-10) codes U03-U03.9, X60-X84.9, Y87.0.

Septicemia

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given as septicemia (infection of the blood). The organism causing the infection is rarely specified on the death certificate.

International Classification of Diseases (ICD-10) codes A40-A41.9.

Chronic Liver Disease and Cirrhosis

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given as cirrhosis of the liver or chronic liver disease.

International Classification of Diseases (ICD-10) codes K70-K70.9, K73-K74.9.

Other Causes of Interest

Smoking-Attributable (estimated)

An estimate of the number of resident deaths over the eleven-year period which were attributable to smoking. This is the only mortality indicator for which the numbers of events are estimates. All other mortality numbers are counts of actual death certificates. The table below shows the smoking-attributable fractions used in calculating the estimates in these profiles.

Smoking-attributable deaths are estimated based on smokers' greater likelihood (relative risk) of dying of various diseases. The Office on Smoking and Health (OSH) within the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention reviews biomedical studies to identify diseases causally related to (cigarette) smoking and to estimate how much more likely smokers are than non-smokers to die of those diseases.

To calculate estimates of smoking-attributable deaths for states, OSH developed a software program called SAMMEC (Smoking-Attributable Morbidity, Mortality, and Economic Costs). SAMMEC uses relative risk formulas to estimate the number of smoking-related deaths from selected diseases. Over the years, more conditions have been linked to smoking, and differences in relative risk by gender and age have been identified. SAMMEC has been revised periodically to take new information into account.

SAMMEC also incorporates estimates of the prevalence of smoking in the population from survey data from the Behavior Risk Factor Surveillance System. The algorithm below used prevalence estimates for Missouri 2001-2005. (Updating prevalence estimates makes very small changes in the smoking-attributable fractions.) SAMMEC then calculates disease- and gender-specific smoking-attributable fractions by age group. Finally, those fractions are applied to the disease- gender- and age-specific numbers of deaths from smoking-related diseases in the population to derive an estimate of smoking-attributable deaths. Estimates in these profiles apply fractions calculated from national and state data to smaller areas; this may introduce additional error.

Like SAMMEC, this algorithm omits deaths in fires and automobile crashes caused by smoking. Unlike SAMMEC, it also omits deaths of infants due to the mother’s smoking.

Relative risk ratios are updated periodically in light of new research. In addition, SAMMEC now includes deaths attributed to secondhand smoke. However, this algorithm cannot be updated in the way in which it was created, because SAMMEC is no longer available to states to enter their population, mortality and prevalence data. Rather, OSH calculates and publishes estimates by state. Updated data from OSH can be obtained from https://www.cdc.gov/statesystem/index.html.

A detailed description of how OSH estimates smoking-attributable morbidity and mortality can be found in chapter 12 of the U.S. Department of Health and Human Services The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

All Injuries and Poisonings

The total number of resident deaths over the eleven-year period for which the underlying cause of death was given on the death certificate as any injury or poisoning. That is, it is a count of deaths not attributed to diseases.

This includes deaths due to homicide, suicide, and accidents, as well as injuries for which the intent is undetermined. Also included are late effects of injuries and of war.

International Classification of Diseases (ICD-10) codes U0-Y89.9.

Homicide

Resident deaths during the eleven-year period for which the deceased was intentionally assaulted or killed by another. Delayed effects of assault are also included. Since 1999, the proportion committed with guns has increased from about two-thirds to over eighty percent (2015 ff.).

International Classification of Diseases (ICD-10) codes U01-U02, X85-Y09.9, Y87.1

Alcohol-Induced Deaths

The total number of resident deaths over the eleven-year period for which the underlying cause of death given on the death certificate was related to alcohol use.

Deaths are included if attributed to dependence, nondependent use, accidental poisoning, or suicide. In addition, alcoholic polyneuropathy, cardiomyopathy, and gastritis are included, as are chronic liver disease and cirrhosis when specified as due to alcohol.

Not all deaths due to alcohol use are included in this count. Some of those not captured here are: alcohol-related motor vehicle accidents, falls, or fires, homicides and suicides committed under the influence of alcohol, and deaths of infants due to the mother's alcohol use.

For alcohol-induced deaths, the International Classification of Diseases (ICD-10) codes are: E24.4, F10-F10.9, G31.2, G62.1, G72.1, I42.6, K29.2, K70 -K70.9, K85.2, K86.0, R78.0, X45 -X45.9, X65 -X65.9, and Y15-Y15.9.

The selection of International Classification of Diseases (ICD-9) codes for this category is taken from standard codes for drug-induced deaths and alcohol-induced deaths from the National Center for Health Statistics. They can be found in "Deaths: Final Data for 2014," National Vital Statistics Reports, Vol. 65, Number 4, June 30, 2016. F10.0 is no longer a valid code for mortality (effective 2007), but is listed here because it was valid during part of the eleven-year period.

Drug-Induced Deaths

The total number of resident deaths over the eleven-year period for which the underlying cause of death given on the death certificate was related to drug use. Deaths are included if attributed to dependence, nondependent use, accidental poisoning, or suicide.

Not all deaths due to substance use are included in this count. Some of those not captured here are: drug-related motor vehicle accidents, falls, or fires; homicides and suicides committed under the influence of drugs; and deaths of infants due to the mother's drug use.

The selection of International Classification of Diseases (ICD-10) codes for this category is based on a list of codes for drug-induced deaths and alcohol-induced deaths from the National Center for Health Statistics (NCHS). It can be found in National Vital Statistics Reports, Vol. 65, Number 4, June 30, 2016. Although a large number of possible drug-induced diseases are included in the list, the vast majority of drug-induced deaths (over eighty percent for 2014-2015) are due to accidental poisoning by overdose or by interaction of drugs (X40-X44.9).

Effective 2009, the NCHS no longer considers the following codes valid for underlying cause of death: F11.0, F12.0, F13.0, F14.0, F15.0, F16.0, F17.0, F18.0 and F19.0. However, they are included here because the profile data include years prior to 2009.

International Classification of Diseases (ICD-10) codes: D52.1, D59.0, D59.2, D61.1, D64.2, E06.4, E16.0, E23.1, E24.2, E27.3, E66.1, F11.0-F11.5, F11.7-F11.9, F12.0-F12.5, F12.7-F12.9, F13.0-F13.5, F13.7-F13.9, F14.0-F14.5, F14.7-F14.9, F15.0-F15.5, F15.7-F15.9, F16.0-F16.5, F16.7-F16.9, F17.0, F17.3-F17.5, F17.7-F17.9, F18.0-F18.5, F18.7-F18.9, F19.0-F19.5, F19.7-F19.9, G21.1, G24.0, G25.1, G25.4, G25.6, G44.4, G62.0, G72.0, I95.2, J70.2, J70.3, J70.4, K85.3, L10.5, L27.0, L27.1, M10.2, M32.0, M80.4, M81.4, M83.5, M87.1, R50.2, R78.1-R78.5, X40-X44.9, X60-X64.9, X85-X85.9, and Y10-Y14.9.

Injury by Firearms

This includes all resident deaths during the eleven-year period for which the underlying cause of death given on the death certificate was attributed to a firearm, whether the intent was homicide, suicide, accident, undetermined or legal intervention.

International Classification of Diseases (ICD-10) codes U01.4, W32-W34.9, X72 -X74.9, X93 -X95.9, Y22 -Y24.9 and Y35.0.

This definition in ICD-10 terms can be found in "Deaths: Final Data for 2014," National Vital Statistics Reports, Vol. 65, Number.4, June 30, 2016 and in other NCHS publications.