Death of Old Age and the Epidemic of Coronary Heart Disease

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.