Trends of Diarrheal Disease—Associated Mortality in US Children, 1968 Through 1991

OBJECTIVES: To describe temporal patterns in mortality related to diarrheal disease in US children and to assess progress toward its prevention and control. DESIGN: Retrospective analyses of death certificate data on diarrhea of all causes compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Ga. PATIENTS: Children aged 1 month through 4 years who died with diarrhea. SETTING: United States, 1968 through 1991. RESULTS: A total of 14 137 deaths associated with diarrhea among children were reported in the United States between 1968 and 1991. Of these, 78% occurred in infants (ie, aged 1 to 11 months); the median age at the time of death has declined from 5 to 1.5 months. Diarrheal disease mortality dropped by approximately 75% during the first 18 years of the study, but no decline has occurred since 1985. Infant mortality due to diarrhea (per 100 000 live births) averaged 12.8 and was found to be high for blacks (33.1) and for residents of the southern United States (18.5). The infant mortality due to diarrhea from 1986 through 1991 is 5.9. Peaks in winter deaths previously associated with rotavirus were prominent in the early years among infants aged 4 through 11 months. Such peaks have virtually disappeared since 1985. Diarrhea was the principal cause of death, as the leading associated diagnoses (electrolyte disorders [30%], cardiac arrest [16%], shock [8%], and nausea/vomiting [4%]) were commonly recognized complications of diarrhea. Since 1979, prematurity has emerged as a common associated diagnosis. CONCLUSIONS: Diarrheal deaths nationwide have declined 75% from 1968 to 1985 but stabilized since then at about 300 deaths per year. Because many of these deaths may still be preventable by early rehydration, future prevention efforts should be directed at educating health care providers about the continuing problem and recognition of the high-risk infant and at teaching mothers of such infants to begin rehydration early and to seek medical attention when their infant develops diarrhea.