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DEATHS

There were 4,933 resident deaths in 1998, a crude death rate of 8.3 per 1,000 population, slightly lower than the 1997 rate of 8.6. The death rate has fluctuated between 8.1 and 8.6 since 1988; prior to that it had been slowly declining for over two decades. The death rate was 11.2 in 1960, 10.0 in 1970, and 9.0 in 1980. The Vermont death rate was slightly higher than the U.S. white rate until 1970 when the rates came closer together and remained close through 1980. Since 1981, Vermont's death rate has been slightly lower than the U.S. white rate. Comparisons are made to the U.S. white rate because 99.5 percent of Vermont residents who died in 1998 were white (Table C-9).

Almost two-thirds of the resident deaths were due to four major causes: heart disease (29.0%), malignant neoplasms (cancer - 24.5%), cerebrovascular disease (stroke - 6.7%), and chronic obstructive pulmonary disease (C.O.P.D. - 5.0%).

During the past decade, as for the previous 40 years, the three leading causes of death were heart disease, cancer and stroke (Table C-1). Heart disease and cancer accounted for 53.5 percent of the deaths in 1998. The heart disease crude death rate peaked in the 1960's at approximately 439 deaths per 100,000 population. The overall rate has generally been declining since then; although the 1997 rate of 255.0 was slightly higher than the 1996 rate of 252.4, the 1998 rate has decreased to 242.4. The crude death rate from stroke, the third leading cause, has also decreased significantly from a peak of 132 in the period from 1959 to 1961 to 54.5 in 1996, slightly increasing to 58.2 in 1997, and decreasing to 56.0 in 1998. These dramatic declines in heart disease and stroke are even more remarkable given that the average age of the population has increased. Cancer crude death rates rose from 167 in the period from 1969 to 1971 to 208.8 in 1997, but decreased slightly to 204.6 in 1998. This trend is in part a result of the aging of the population and the rising lung cancer death rates.

Chronic obstructive pulmonary disease has been the fourth leading cause of death since 1985. The death rate from this cause rose from 31.1 in the period from 1979 to 1981, when it was first counted in this way, to 48.6 in 1997, before decreasing to 42.1 in 1998. Influenza/pneumonia and unintentional injuries frequently reverse order as the fifth or sixth cause of death. In 1998 pneumonia and influenza had a crude rate of 40.1 deaths per 100,000 population while the rate for unintentional injuries was 35.5. The mortality rate for influenza and pneumonia has been relatively stable while the unintentional injury mortality rate has been decreasing. The crude death rate from unintentional injuries peaked in 1969 to 1971 at 58.4 and declined to an all time low of 29.8 in 1994 prior to slightly increasing in recent years. (The term unintentional injury is used rather than the term accident because it acknowledges the possibility of identifying factors that increase or decrease the risk of injuries.)

Diabetes was the seventh leading cause of death with a crude death rate of 22.5. Although this represents a decrease from 1997, diabetes mortality has generally increased over the last 10 years. Suicide and diseases of the arteries were the eighth and ninth leading causes respectively, each of these causes having a relatively stable rate over the past 30 years. Alzheimer's disease remained in the top ten causes with a crude death rate of 11.9 per 100,000 population.

The leading causes of death varied considerably with age (Table C-2). Among infants, the leading causes of death were congenital anomalies. Unintentional injuries were the leading cause of death for people age 1 to 34 (Table C-14). Cancer, followed by heart disease, were the leading causes of death among people ages 35 to 74. After age 75, heart disease was the leading cause of death.

Death rates dramatically increase after age 75. Deaths after this age accounted for 60.0 percent of total deaths, while people age 75 and over accounted for only 5.7 percent of the total population. Except for influenza and pneumonia, the leading causes of death in this age group are all chronic diseases.

Deaths occurring in a hospital accounted for 41.6 percent of Vermont resident deaths (Table C-21). The percentage of deaths occurring in hospitals has been declining, from 62 percent in 1980 and 53 percent in 1990. In 1998, 23.1 percent of Vermont deaths occurred at home, and 26.4 percent occurred in a nursing home.

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