252648 Death of Old Age and the Epidemic of Coronary Heart Disease

Tuesday, November 1, 2011: 12:50 PM

Carla Keirns, MD, PhD, MSc , Center for Medical Humanities, Compassionate Care & Bioethics, Stony Brook University, Stony Brook, NY
The campaign against old age—at least on death certificates—was a long time coming. While old age was banished from the recognized lists of causes of death in the early twentieth century, to the consternation of statisticians, physicians continued to certify deaths due to “old age.” From 1880 to 1933, the Census Bureau made efforts to improve the quality and comparability of death certificate data. A pamphlet was sent by the US Census department to every licensed physician in the United States 10 times between 1903 and 1939. The pamphlets showed particular contempt for the laziness of physicians listing “old age”, instructing in 1903: “Old Age: List the disease causing death in the old person. The statement ‘old age' in the vast majority of cases, is simply equivalent to unknown, and shows lack of observation and precision of statement.” Old age appeared as code 167 in International Classification of Diseases 1 (1900), and was banished in editions 2 throu 4, and reintroduced in the 5th edition in 1938 with subcategories of “senility” with and without dementia. In 1948, ICD-6 did away with “old age.” The banishing of uncertainty from the classification system, however, did not remove it from the clinical certification of death, and this paper will use historical mortality statistics for the US to illustrate that some of these deaths were reclassified into categories of cardiac mortality, which was already being recognized as a the leading cause of death in the United States.

Learning Areas:
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Explain the ways that changes in death classification rules and categories can alter mortality statistics. Analyze health statistics over long periods with greater insight, particularly to the effect of broad changes in disease ecology and life expectancy on classification.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to give this presentation because I have been doing research and publishing on the history of chronic disease and death certification in the United States for over 10 years
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.