Causes of Death, Historical Perspectives

Through time there have been significant changes in the major causes of death for human populations. The major causes of death have changed from infectious and parasitic diseases to chronic conditions, such as heart disease and stroke. Numerous factors have influenced the changing causes of death, including nutrition and diet, personal hygiene, exposure to new environments or contagions, public health measures, changing perceptions of the causes of disease and illnesses, and medical advances and discoveries. With the historical changes in causes of death has come an increase in average life expectancy, particularly during the 20th century.

This entry outlines some of the major historical trends in causes of death, primarily for the United States, as well as the factors that are associated with such changes. The first section discusses the sources of data available to conduct a historical study of causes of death. The next three sections examine major causes of death during the colonial period, the 19th century, and the 20th century. The final section examines early 21st-century trends with a view toward future causes of death.

Data Sources and Data Quality

Records of death rates, causes, and differentials are limited in coverage for the United States before the late 1800s. Thus, information about mortality trends from colonial times until the mid-19th century is based upon data collected in smaller geographic units, such as cities or reporting states. Much of the early information about deaths was derived from personal journals, diaries and letters, newspaper accounts, or other public records. Deaths were not regularly reported or recorded in all areas, and this was particularly true of infant and child deaths. Church records and family histories can provide information about births, marriages, and deaths; however, much of the information is missing, somewhat inaccurate or incomplete (such as infant deaths occurring before baptism), or not analyzed in a systematic fashion.

The decennial census, beginning in 1790, established an important source of demographic data. [Page 164]However, mortality information was not collected in the census until the mid-1800s, and the information was not consistently recorded in the public record. Individual states and the federal government were slow to develop vital registration systems to record demographic events, such as marriages, births, and deaths. In 1900, the federal government began publishing annual mortality statistics, based upon the newly established death registration system. The initial death registration area included 10 states, the District of Columbia, plus 153 cities not in the death registration states. Through the years additional states were included, and by 1933 the death registration system covered all of the United States.

Colonial Period Mortality Trends, 1600–1800

During the colonial period the major causes of death were primarily infectious diseases. Regional differences in death rates across colonial America were due to differences in rates of disease transmission and survival, immunity to disease, and the methods used to treat or prevent the spread of disease.

From 1600 through 1775 smallpox was a major cause of death in Europe and North America. A highly communicable viral disease, the smallpox virus typically is passed from host to host, but it also can remain infectious for months on inanimate objects, including bedding and clothing. Once infected, the person either dies or survives with a long period of immunity. In the urban areas of the Old World—Europe, Asia, and Africa—children were most likely to contract smallpox, and thus, adults were typically immune to the disease. Smallpox was brought to the New World from Britain and the West Indies, and outbreaks were highest in the port settlements, such as Charleston, South Carolina, and Boston, Massachusetts, where new immigrants arrived. Because the arrival of trade and passenger ships was not on a regular schedule, the outbreaks of smallpox were erratic. The periodic smallpox epidemic affected all ages, because the adults living in the colonies were less likely to be immune.

...