CONTRIBUTOR’S
SECTION
ANNUAL
SUMMARY
OF
VITAL
STATISTICS-.I969
Myron E. Wegman, M.D.
From the School of Public Health, University of Michigan
Ann Arbor, Michigan
TABLE I
461
T
HIS year’s summary of vital statisticaldata of particular interest to pediatri-cians is later than usual because the
in-creased complexities of compiling and
is-suing the data on which the report is based
imposed an unexpected delay. As has been noted in previous years,1 the data on which
these reports are based are issued by the
National Center for Health Statistics and
the fundamental material comes from the “Annual Summary for the United States,
1969: Births, Deaths, Marriages and Di-vorces,” published this year October 21,
1970.2 In partial compensation for the
de-lay, more up to date information is possible
on the monthly trends during the year 1970 from the report published October 27,
1970.:
The limitations on the data used are
cx-plained in the references cited. All the data
for 1969 are provisional and are based upon
a 10% sample of materials received in state
offices between two dates 1 month apart,
regardless of when the event occurred.
Ex-perience has shown that for the country as
a whole the estimate is very close to the subsequent final figures. There are,
how-ever, considerable variations in a few of the states; state information should be looked
at more carefully.
During 1969 apparently there were more
births, marriages, and divorces and fewer
deaths than in 1968. The resulting increase of population was 1,660,000, a rate of 0.82%.
This rate of natural increase, although slightly higher than last year, is almost one-third lower than in 1963.
BIRTHS
For the first time since 1962 the number
of births in the United States, 3,571,000, was higher than in the preceding year
(
Table I)
. The crude birth rate of 17.7, also higher than last year, reversed for the first time a downward trend that began in1957-1958. Both of these increases were related
more to the fact that more women are
coming into the child bearing ages than to
an increase at the rate in which women are bearing children. The effect of the high
birth rate in the late 1940’s and early 1950’s
has been to increase the number of women
now in the child bearing ages. Some of the
implications of this trend were discussed in
last year’s review.1
The fertility rate, a sensitive indicator
relating to the number of births to women
between 15 and 44 years of age, was
vir-tually the same as for 1968, 85.8. Figure 1
shows the fertility rate presented as specific
monthly rates and in the form of a
season-ally adjusted moving average. This chart is
\ITAL STATISTICS OF THE UNITED STATES
Data
Total Numb er of Events Rate$ per 1,000 Population
-1969* 1968
-1969* 1968 1965 1960 1950 1940
Births 3,571,000 3,501,564 17.7 17.5 19.4 23.7 24.1 19.4
Deaths 1,916,000 1,930,08’2 9.5 9.7 9.4 9.5 9.6 10.8
Marriages 2,146,000 2,059,000* 10.6 10.3* 9.3 8.5 11.1 12.1
InfantDeaths 74,100 76,’263 20.7 d21.7* 4#{149}7 26.0 29.2 47.0
Sources: references 2 and S.
* Provisional.
‘S
#{149}0
.3
S0
75
ESTIMATED DEATH ltTts Foil TIlE 10 LEADING
(‘AUSFI. 01.- I)E.STII: INITED STATES, 1969
364.1 ‘38.4
160.1
I 0 .0
56.() 34.7 18.5 16.7 15.(; 15.0 145.3
16.9
10.8 5.9 ‘3.7 ‘) ‘) ‘2.0 I .8 1.6 I .6 15.1
462 VITAL STATISTICS-1969
To
is.. ui its. ,u, mo
FIG. 1. Seasonally adjusted fertility rates: United States, 1966-1970.’
extended into the first several months of
1970 and suggests that by the end of 1970 there may be a slight increase in fertility.
MARRIAGES
Once more 1)0th the number, 2,146,000,
and the rate of marriages, 10.6 per 1,000
population, exceeded the previous year
(
Table I).
The number was the highest since 1946 and the rate the highest since 1950. Monthly trends in 1970 suggest someleveling off.
DEATHS
The total number of deaths, 1,916,000, and the death rate, 9.5 per 1,000 population, were slightly lower than in 1968. No major
epidemic of influenza, often the chief van-ant in influencing the crude death rate, oc-curned in 1969. The pattern of monthly
variation was similar to other years, high-est in the winter months and lowest in the summer and early fall. There was no change in ranking of the causes of death
(
Table II).INFANT MORTALITY
It is again highly gratifying to report a
decline in infant mortality, to an estimated
74,100 deaths under 1 year of age, or an
estimated rate of 20.7 per 1,000 live births.
This is the lowest rate ever recorded in the
United States and its consistency was shown
by the fact that in each month of 1969 the
I05 rate equalled or surpassed the record low
for that month. The decline was manifest
both in the neonatal rate, 15.4, and the post-neonatal rate, 5.4. As in the case of the
total death rate, there was little change in the relative distribution of the common
causes of infant death.
In last year’s article there was mention
that the disturbing differential decline of previous years, with the rates of the “white” population dropping fasten than for the “all
other” group, appeared to be changing, and
the latter showed substantially greater im-provement. In 1969 the decline appeared to be at about the same rate for both groups. This still leaves an age specific death rate
of 32.1 for the “all other” population under 1 year of age, 71% higher than the
compa-rable rate of 18.8 for the “white” popula-tion. From a pediatric public health stand-point it should certainly be possible to
achieve a more rapid decline in the group
with the higher rate. The implications noted
last year are still valid.
Geographically the decline in infant mor-tality was seen in most states
(
Table III), 39 reporting lower provisional rates in 1969and 11 showing an increase over the
corn-TABLE II
(‘auxe of Deal/i ( Eighth Revision International (‘lai.sificatiori of
J)i.eavei, Adapted, uh1i/;)
Death Ilale Percent of Total Deaths
All causes 948.9 lffl).0
1 l)iseases of heart
\Ialignaiit neoplIlsilis,
includ-ing neoplasins of lymphatic and
heniatopoietic tissues
S Cerebrovaseular (hiseases
4 Accidents
5 1nfluenza an(l pHeutnoilia
6 Certain causes of niortahit’s’ in
earl’s’ infancy
7 Dial)etes iuehlitu.s
8 Arteriosclerosis
9 Bronchitis, einphiysenia, and
asthma
10 Cirrhosis of liver
parable rate for 1968. Similarly in 1969, 25
states showed provisional rates under 20
per 1,000 live births as against 20 states with
such levels in 1968. Four states in 1969 had
provisional rates below 17 : Nebraska 13.2, Minnesota 16.3, Oregon 16.7, and Utah and
LIVE BIRThS, BIRTh RATF, AND INFANT MOOTALITY
RATKS, BY PLACE OF OCCUIIHENCE
Live Births Infant forta1itY Itale
:lrca 1969 1969 1969 1968 19X
North Dakota 16.9. It must be emphasized again that individual state rates are subject to change when final figures are in. For
in-stance, three of the states on the above list, particularly Nebraska, showed higher rates
when the final figures for 1968 were
re-Number !?(l’C (F,n(zl)
New England O,I49 17.6 18.4 20.1 19.9 Iairie 17,520 17.9 17.8 19.7 21 Newllampsbire. 1,S90 17.3 18.6 18.9 18.8 Vermont 7,81 17.8 t.() 19.5 18.6
Massachusetts. .. 99,54 18t 18. 1 ‘20.9
Rliodelsland 15,87 17.4 19.3 I.O O.9
Connecticut 49, 104 16.4 18.4 18.9 19.1
ported. Again, only one state, Mississippi,
showed a rate higher than 30 but this state’s
Middle Atlantic 6I,877 16.4 O.9 2lt NewYork 471 17.1 1.3 QI.t 21.0 NewJersey 114,18.5 16.0 19.3 20.4 0.7
provisional rate of 30.6 represents a distinct
improvement, 13%, over the 1968 figures.
Pennsylvania 186,221 15.8 21 .1 21.7 21 .8
EastNorthCentral. .705,8.58 17.7 20.2 21.5 2I.5 Ohio 184,253 17.2 19.1 20.0 i0.S
The improvement augurs well for further
progress.
Indiana 91,666 17.9 20.3 22.2 ‘1.8
lllitiois 192,48 17.4 2.3 3.I 3.1
Michigan 163,729 18.7 20.3 21.8 2I.8
Internationally,
(
Table IV)
the declinein United States infant mortality was more than matched in other countries. The United States, in this Table, is in 15th place instead
of 14th as in last year’s table. Question is
frequently raised as to comparability of
figures from various countries because of
difference in adherence to the World Health
%Sisconsin 73,728 17.4 17.0 18.1) 1)2 IVest North Central .277,867 17.2 18.2 19. 1 19.7
Minnesota 65,788 17.8 16.3 18.0 18.5
47,791 l7. 18.8 19.4 19.3
Missouri 81,617 17.5 20.7 20.9 21.6 NorthDakota. . 11,296 18.4 16.9 17.6 17.4
South Dakota. . . 11,393 17.3 19.1 20.8 20.4
Nebraska. . 24,345 16.8 13.2 14.0 18.1
Kansas 35,637 15.4 18.7 20. I 20.1
SouthAtlantie 549,487 18.0 23.1 24.3 24.4
Delaware. . . 10,399 19.3 21.9 18.9 19.8 Maryland 60,538 16.1 19.9 22.2 22.5
Organization definition of live birth (heart beat, respiration, movement of voluntary muscle, or pulsation of umbilical cord), in
reporting procedures and in completeness of registration. It should be noted that all
DistrictofColumbia 27,358 34.3 25.6 25.4 22.1
Virginia 78,543 16.8 22.8 23.0 23.2
WestVirginia. . ..
:
29,384 16.2 22.8 23.2 23.8NorthCarolina 93,972 18.1 25.0 26.9 26.5
South Carolina .50,473 18.7 23.8 27.4 26.5 Georgia 91, 102 19.6 23.3 23.3 25.1 Florida 107,718 17.0 22.7 24.3 24.2 EastSutiCentrl 241,999 18.3 25.0 26.0 26.3
countries in the Table are classified as hay- Kentucky 57,990 17.9 22.2 21 .0 21.6
ing complete reporting. Moreover, Taiwan, AlabamaTennessee 73,85762,840 18.517.8 22.426.4 ‘24.026.0 24.226.7
with a rate of 19.0 in 1968, is excluded
be-cause its data do not include live born
in-Mississippi 47,312 20.0 30.6 35.2 34.7
IVest South Central. 369,312 18.9 21 .5 22. 5 22.7 Arkansas 33,337 16.7 18.6 21.8 22.6
fants who die before they are registered. The matter of comparability has been
dis-cussed in an exchange of correspondence in
the letters column of PEDIA’rmcs6 and in
Louisiana 74,584 19.9 24.4 25.4 2.1 Oklahoma 41,691 16.2 19.8 19.8 19.9 Texas 219,700 19.6 21.4 22.1 22.4
Mountain 159,526 19.9 20.9 20.6 21.0
11,649 16.8 19.7 19.5 19.2
Idaho 13,019 18.1 18.3 17.8 17.7 several scholarly publications,5’7 with the
conclusion that difference in reporting
pro-Wyoming 5,913 18.5 24.9 19.2 19.3
Colorado 39,936 19.0 21.7 19.9 20.4 New Meak 21,494 21.6 23.8 25.3 23.0
cedures cannot account for more than a Arizona 33,983 20.I 22 .0 20.3 21.7
small percentage of the observed difference. UtahNevada 24,6218,911 23.619.5 20.316.9 27.417.8 26.518.7
Furthermore, most of the European
coun-tries have a long tradition of complete civil
Pacific 458,841 17.7 18.3 18.9 19.2
Washington 56,687 16.7 19.2 19.3 19.9
Oregon 34,486 17.0 16.7 19.9 19.8
registers while only in 1915 did the United States establish its Birth Registration Area,
California 345,145 17.8 18.2 18.7 19.0
Alaska 6,821 24.2 18.8 20.3 20.7
hawaii 15,702 19.8 19.0 18.8 18.8
with 10 states and the District of Columbia.
Inclusion of all states was achieved in 1935, but even now some states do not surpass the required 90% level by very wide margins.
Puerto Rico. 67,435 24.5 26.1 27.3
Virgin Islands (U.S.) 2,529 - - 32 .8
Data are provisional unless otherwise specified. Birth rate
per 1,000 total population. Infant mortality rate per 1,000
T1SNO: SATES ov succnsivv 12.MONTH PESIODS ENDING WITH EACH MONTH INDICATED .IP*ANT MOITAUTY lATE
pa. usc
.
-
S.., ‘Illity of the comparison shown was
demon-strated in a study of “post-perinatal
mor-tality” rates, that is, deaths between 7 days
and 1 year, per 1,000 live births.8 In such
‘FABLE IV
INFANT MOIITALITY RATES FOR SELF:CTED COUNTRIES
(‘ountry
Rate
1908 1969
464 VITAL STATISTICS-1969
Fic. 2. Infant mortality rates, by month: United States, 1966-1970.’
Swedeti
Netherlands
1’2.9t
13.6 1’3. 1
Norway
Finland
13.7
14.4 13.9
Japan
Deniiiark
14.9j
15.8t
15.3*
Switzerland 16.1
Australia 17.8*
New Zealand 18.7 16.9
United 1’iiigdons
France
18.8*
t0 .4* 164*
East Germany
Canada
fs.4
‘20.8
Irehand 21.() 20.6*
United States ‘21.8
Czechoslovakia 22 .1 ‘.22 9*
West Germany
Belgium
Israel
.8
2.2.9t
‘t4.8 23.0*
Austria 5.5 )54*
1-ssit 6.4
Bulgaria
Spain
Italy
Poland
28.3 3)()*
3))*
‘33.4
30.5* 29.8*
3()#{149}3*
34 .
Source: Heference 4.
Lowest 25 countries withi population ‘2.5 million or
more.
* Provisional.
1-Itate for 1907.
a rate the question of reporting or erroneous
classification as a stillbirth is essentially
eliminated. The relative position of the United States was still distinctly unfavor-able and had worsened in the period under
study, 1956-1966.
Rather than seek tortuous analyses to
ex-plain
away the differences reported in gen-erally available data, it behoovespediatri-cians and public health workers to insist on general application of personal and environ-mental measures which can bring what is
clearly an achievable improvement in health
status to our whole population.
REFERENCES
1. Wegman, M. E. : Annual summary of vital
sta-tistics-1968. PEDIATRICS, 44: 1031, 1969.
2. National Center for Health Statistics. Monthly
Vital Statistics Report, Vol. 18, No. 13,
Octo-ber 21, 1970.
3. National Center for Health Statistics, Monthly Vital Statistics Report, Vol. 19, No. 8, October
27, 1970.
4. Demographic Yearbook, 1969. New York: United Nations, 1970.
5. Chase, H. E. : Ranking countries by infant
mor-tality rates. Public Health Rep., 84, January
1969.
6. Nickey, L. N., Moriyama, I. M., and Yankauer, A. : Factors affecting reports of neonatal
deaths in United States and elsewhere.
PE-DIATRICS, 45:1042, 1970.
7. International comparisons. In Shapiro, S.,
Schlesinger, E. R., and Nesbitt, R. E. L., Jr.: Infant, Perinatal, \Iaternal and Childhood
Mortality in the United States. Cambridge,
Massachusetts: Harvard University Press, p.
114, 1968.
8. Wegman, M. E. : International trends in
post-perinatal mortality. Amer. J. Dis. Child., in
