key findings

Overall, San Mateo County rates for most causes of death compare favorably and meet Year 2000 objectives, with the exceptions of stroke and drug-related deaths, which fail to satisfy Year 2000 objectives. Also, death rates among African-American residents are much higher for most leading causes of death.

leading causes of death

• In San Mateo County, cancer is the number-one killer (accounting for 25.8% of 1996 deaths), followed closely by heart disease (24.1%); these disease groupings account for roughly one-half of the deaths in San Mateo County. In addition, stroke accounted for 10% of deaths in 1996. ⁵⁴⁰

• Between 1993 and 1996, there was a 47.5% decrease in homicide deaths in San Mateo County, as well as a 34.5% decrease in AIDS deaths. ⁵⁴¹

• Less dramatic increases were noted for pneumonia/influenza (6.1% increase), cancer (4.9%) and stroke (3.8%). ⁵⁴²

• The following chart outlines the 1994-96 annual average ranked causes of death in San Mateo County by age group. Note that congenital abnormalities are the leading cause of death for infants, while unintentional injuries are the leading cause among children and young adults aged 5 to 34. For those aged 35 to 74, cancer was the leading cause of death. Heart disease was number one for those aged 75 and older. ⁵⁴³

• Among the combined segment of 15- to 44-year-olds, the total number of cancer deaths increased 18% between 1993 to 1996. ⁵⁴⁴

• Measured in terms of deaths per 100,000 population, 1994-1996 annual average death rates among African-American residents are much higher for most leading causes (with the exception of suicide, which is highest among Whites), including:

*  Heart disease (121.8 per 100,000 vs. 79.9 per 100,000 overall)
*  Cancer (160.1 per 100,000 vs. 116 per 100,000 overall)
*  Stroke (52 per 100,000 vs. 28.8 per 100,000 overall)
*  AIDS (55 per 100,000 vs. 12.4 per 100,000 overall)
*  Homicide (18.2 per 100,000 vs. 5.3 per 100,000 overall)
*  Injury (29.4 per 100,000 vs. 18.2 per 100,000 overall) ⁵⁴⁵

 

potential life lost

Although the number of deaths in a given year gives some insight into the causes of death and factors contributing to these deaths, it does not adequately describe the impact of premature death. Years of potential life lost (YPLL) represents the number of years lost to premature death (here, this includes deaths occurring prior to age 75). YPLL is calculated by adding all the years of life left to age 75 at the time of death.

• Using YPLL measures, there were 130,655 years of potential life lost among San Mateo County residents between 1992 and 1996. Cancer, unintentional injury and heart disease took the greatest number of collective years of potential life. ⁵⁴⁶

• In terms of average number of years of life lost per death between 1992 and 1996, homicide and AIDS stole the greatest average number of years (44.1 and 34.2 years per death, respectively). These are followed by unintentional injuries (29.6 years per death) and suicide (29.3 years per death). ⁵⁴⁷

age-adjusted death rates for selected causes

Yet another means of comparing deaths among different populations is to use age-adjusted death rates. Age-adjusted rates compensate for varying population sizes by measuring deaths per 100,000 and compensate for bias against comparatively younger or older populations by adjusting death rates to a common age baseline.

• As can be seen in the adjacent chart, San Mateo County enjoys a relatively low age-adjusted death rate (386.5 deaths per year per 100,000 residents) compared to California as a whole (454.2 deaths per year per 100,000 residents). ⁵⁴⁸

The following chart outlines the 1994-1996 annual average age-adjusted death rates for selected causes of death in San Mateo County, as well as neighboring Santa Clara County and California. Also included are the Year 2000 objectives set forth in Healthy People 2000: National Objectives for Health Promotion and Disease Prevention.

• By and large, San Mateo County experiences rather low death rates for most leading causes of death and meets nearly all of the Year 2000 objectives. The exceptions are the elevated stroke rate in San Mateo County (which is slightly higher than the state rate and fails to satisfy the Year 2000 objective) and the rate of drug-related deaths (which, although lower than the state rate, fails to satisfy the Year 2000 objective). ⁵⁴⁹

actual causes of death

While the leading causes of death discussed previously indicate the primary pathophysiological conditions identified at the time of death, they do not speak to the root causes of death. Conditions causing death include a combination of hereditary and external factors such as risk behaviors and injuries. A model has been developed by the U.S. Department of Health and Human Services, as presented in the Journal of American Medical Association (McGinnis & Foege, 1993), to identify and quantify the major external (non-genetic) factors that contribute to death in the United States. ⁵⁵⁰

• By applying this model to 1996 deaths in San Mateo County, an estimated one-half of deaths (translating to 2,459 deaths in 1996) were attributable to external factors, including risk behaviors. Tobacco was the root cause for approximately 19% of all 1996 deaths, poor diet and physical inactivity the root cause for 14%. ⁵⁵¹

551  Ibid.