Trends in Cause-Specific Mortality by Race and Hispanic Origin, 1999–2019

Infectious and Parasitic Diseases

In 2019, the shares of all deaths that were attributed to the category “certain infectious and parasitic diseases” ranged from 2.1 percent for the WNH community to 3.3 percent among Black individuals. The category consists of the six infectious and parasitic disease subcategories listed in Box 11.

Chart 38 shows the number and percentage distribution of infectious and parasitic disease–related deaths by cause-of-death subcategory for 1999 and 2019, with detail by RE group and age. In 1999, HIV constituted only 8.7 percent of all infectious and parasitic disease–related deaths among API people and 12.5 percent of such deaths in the WNH community, but 43.2 percent of those in the Hispanic population and 49.1 percent among Black people. The HIV share of infectious and parasitic disease deaths is disproportionately higher for males than females and for Black and Hispanic people than members of the other RE groups. For instance, the percentage of all-ages infectious and parasitic disease–related deaths that were attributed to HIV in 1999 were 58.4 percent among Black males and 35.8 percent among Black females. The HIV share of infectious and parasitic disease deaths peaked in the midlife ages. In 1999, HIV was the leading cause of infectious and parasitic disease deaths at ages 25–64 in all RE/sex groups other than API men (for whom viral hepatitis was a larger factor) and WNH and API women (for whom sepsis and viral hepatitis, respectively, contributed a larger share of deaths). By 2019, the proportion of infectious and parasitic disease deaths attributed to HIV had declined dramatically, thanks in part to the continued use of highly active antiretroviral therapy. From 1999 to 2019, the percentage of infectious and parasitic disease–related deaths caused by HIV at all ages declined from 49.1 percent to 22.4 percent in the Black population.

Chart 39 shows age-adjusted death rates for 1999–2019 by RE group, sex, and age group. Panel A shows the rates for infectious and parasitic diseases overall.

Chart 39, Panel B shows that Black males had the highest all-ages HIV mortality rates, followed by Black females and Hispanic males. In 1999, the all-ages mortality rate among Black males (36.1) was 9 times greater than that of WNH males (4.0). Likewise, the all-ages HIV-related death rate for Black females and Hispanic males exceeded the HIV mortality rate for WNH males by factors of 3.3 and 2.7, respectively. From 1999 to 2019, for every RE/sex group, all-ages HIV mortality rates declined, and at ages 25–64, the rates declined substantially. Over all ages combined, the HIV mortality rate in 2019 was less than one-fourth the 1999 rate among Black males and Hispanic males and females, and less than one-third the 1999 rate among Black and API females and WNH males. Nevertheless, enormous racial disparity remained. In 2019, all-ages HIV mortality rates among Black males, Black females, and Hispanic males exceeded that of WNH males by factors of 7.4, 3.2, and 2.0, respectively.

Sepsis refers to blood poisoning (infection with streptococcus or other bacteria). In 2019, sepsis was the leading cause of infectious and parasitic disease deaths in all RE groups, accounting for 47.0 percent of those deaths among API people, 48.0 percent of those among Hispanic people, 55.1 percent of those among Black individuals, and 62.5 percent of such deaths in the WNH population. The percentages are typically higher among females than males and at older ages than for younger groups.

Chart 39, Panel C shows that in 1999, Black males and females had the highest all-ages sepsis mortality rates (28.9 and 21.9, respectively), followed by WNH males (11.1). Hispanic males and WNH females both had all-ages sepsis death rates close to 10, while API males and females had the lowest mortality rates (7.8 and 5.6, respectively). From 1999 to 2019, all-ages sepsis mortality rates declined in all RE/sex groups, especially among the non-WNH groups. For instance, in 1999, the all-ages sepsis mortality rate for Black males (28.9) was 2.6 times that of WNH males (11.1). By 2019, the death rate among Black males had dropped to 17.9, or 1.7 times that of WNH males. Sepsis mortality rates at ages 65 or older decreased more rapidly than those of the other age groups over the observation period; in fact, at ages 25–64, mortality rates increased for API women and for WNH and Hispanic individuals of both sexes.

Viral hepatitis accounted for disproportionately high shares of infectious and parasitic disease deaths in the API and Hispanic communities. In 1999, for example, it represented almost one-quarter of such deaths in the API population. In 2019, the shares of infectious and parasitic disease deaths that were attributed to viral hepatitis were 5.4 percent for Black people, 6.0 percent among the WNH population, 11.4 percent for Hispanic people, and 11.7 percent in the API community. There is substantial racial disparity in the prevalence of hepatitis B and C in the United States, with API individuals exhibiting disproportionately high infection rates for hepatitis B virus and Hispanic and Black groups experiencing higher prevalence for hepatitis C virus (Carrion and others 2011; Kim and others 2017). In addition, the opioid crisis has exacerbated infection rates (CDC 2017).

Chart 39, Panel D shows that Hispanic males had the highest all-ages hepatitis mortality rates for most of the 1999–2019 period, followed by Black males. API males had higher death rates than WNH males before 2005 and again from 2017 to 2019. Among females, the Hispanic RE group had the highest all-ages hepatitis mortality rate, while the WNH group had the lowest mortality rate through most of the period. From 1999 to 2019, the all-ages hepatitis death rate declined by more than half for Hispanic and API males, as well as for API, Hispanic, and Black females. There are also significant differences by age group. For example, at ages 65 or older, API and Hispanic men and women had higher hepatitis mortality rates than other groups until 2010. At ages 25–64, however, API women had the lowest mortality rates each year after 2001.

The percentage of infectious and parasitic disease deaths caused by intestinal infections rose dramatically over the study period. In 1999, intestinal infectious diseases accounted for 2.7 percent of infectious and parasitic disease deaths among WNH people and less than 1 percent of those deaths among all other RE groups. By 2019, the shares of infectious and parasitic disease–related deaths that were caused by intestinal infections were 12.7 percent among WNH people, 11.2 percent among Hispanic individuals, 10.4 percent among API people, and 6.6 percent among Black individuals. The percentage tends to be higher among women than for men. It peaks at the oldest ages; for example, intestinal infections account for almost 20 percent of all infectious and parasitic disease deaths for WNH women older than 84.

Chart 39, Panel E shows that the all-ages intestinal infection death rates rose very rapidly from 1999 to 2010 for all RE/sex groups, then declined. In 2019, WNH and Black females had the highest all-ages intestinal infection mortality rates, followed by WNH and Black males; API males and females had the lowest death rates. From 1999 to 2019, all-ages intestinal infection mortality rates increased by factors of 8 for Hispanic females, 5 or more among Black males and females and API and Hispanic males, and more than 3 among WNH males and females.²⁵

The two remaining infectious and parasitic disease cause-of-death subcategories are “other bacterial diseases” and the residual group “all other infectious and parasitic diseases.” Other bacterial diseases represented 4.0 percent of infectious and parasitic disease deaths in 2019 among Hispanic and Black people and 5.4 percent of deaths in the WNH and API communities. The all-ages other bacterial disease mortality rate in 2019 (Chart 39, Panel F) was highest for Black and WNH males, followed by Black and WNH females. “All other infectious and parasitic diseases” includes viral infections of the central nervous system (such as polio, rabies, meningitis, and encephalitis), tuberculosis, protozoal diseases, and sequelae of infectious and parasitic diseases. The percentage of infectious and parasitic disease deaths at all ages attributed to this subcategory ranged from 6.4 percent among Black individuals to 21.4 percent in the API population in 2019, although the shares were substantially higher among those aged 0–24. Chart 39, Panel G shows that in 2019, API males had the highest all-ages other infectious and parasitic disease mortality rate (2.6), followed by Black males (1.9) and Hispanic males (1.8). Among females, the Black population had the highest mortality rate (1.5) and the Hispanic and API groups had the lowest rate (1.2).

Chart 40 shows the all-ages infectious and parasitic disease mortality rates by cause-of-death subcategory, RE group, and sex in 1999 and 2019. In 1999, the death rates attributed to HIV (36.1) and sepsis (28.9) among Black males were so high that either one by itself matched or exceeded the combined mortality rate for all infectious and parasitic diseases in each of the other RE groups. For Black females, the sepsis death rate (21.9) exceeded the combined infectious and parasitic disease death rates of females in the other RE groups, and the HIV death rate (13.1) nearly did so. Black females experienced higher infectious and parasitic disease mortality than any RE/sex group other than Black males. For both sexes, Hispanic people had higher infectious and parasitic disease mortality rates than WNH individuals, as their lower death rates from sepsis were more than offset by higher mortality from HIV, hepatitis, and the residual subcategory all other infectious and parasitic diseases. The API population, on the other hand, had the lowest overall infectious and parasitic disease mortality, as death rates from hepatitis and the other-infectious-disease subcategory, which were higher than those of the WNH population, were offset by lower mortality from sepsis and HIV. By 2019, mortality rates had declined in all RE/sex groups and for most major subcategories (except intestinal infectious diseases), with Hispanic males and females experiencing lower overall infectious and parasitic disease mortality rates than their WNH counterparts. However, the sepsis mortality rates among Black males and females still exceeded the mortality rates for all infectious and parasitic diseases combined in the other RE groups in 2019.