1942: Vital Statistics

Birth, Death, and Stillbirth Statistics in 1941.

In 1941, 2,513,427 births and 1,397,642 deaths were reported to the Bureau of the Census for the United States, an increase of 153,028 births and a decrease of 19,627 deaths, as compared with the corresponding figures for the preceding year. The 1941 birth rate of 18.9 per 1,000 population represents an increase of 5.6 per cent over the rate for 1940 and was the highest recorded for the birth registration area since 1931. The birth rate by states ranged from 15.7 per 1,000 population in New York to 27.8 in New Mexico.

The death rate decreased from 10.7 in 1940 to 10.5 per 1,000 population in 1941, and was the lowest ever reported for the death registration state. The infant and maternal mortality rates also reached the lowest level in the history of the registration system. These death rates in 1941 were 45.3 and 3.2 per 1,000 live births, respectively.

As indicated by the crude death rates, there was a general decline in the death rates for the various selected causes. Of particular health significance is the substantial reduction in the death rate for influenza and pneumonia, which dropped from 70.1 per 100,000 population in 1940 to 63.7 in 1941. There has been a rapid decline in the death rate for this cause since 1937, when the influenza and pneumonia rate was 114.9.

Except for the change of motor-vehicle accidents from the eighth to the seventh position, the rank order of the leading causes of death in 1941 did not differ from that of 1940. The increase in the motor-vehicle accident death rate from 26.1 per 100,000 population in 1940 to 30.0 in 1941 displaced diabetes mellitus as the seventh leading cause of death in 1941.

The natality and mortality statistics for 1941 are of particular significance at this time, since they represent experience for the last pre-war year and will be used as a basis of comparison in determining the general effect of the war on the civilian population in 1942. Provisional figures for the first nine months since the entry of the United States into the war indicate that the 1942 birth rate will be significantly higher than that for 1941. Barring the possibility of any epidemics of unusual proportion, mortality conditions in the country promise to be the most favorable in the history of the United States.

Inter-American Unit.

The Bureau of the Census through its Division of Vital Statistics has developed an Inter-American Unit devoted to cooperation in Vital Statistics with the American Republics. The plan involves the employment of three professionally trained traveling consultants who will, upon the request of any American Republic, consult with, advise, and give technical assistance to the officials of that Republic in a cooperative endeavor to improve their vital and medical statistics organizations and data. Insofar as practicable, this work will be integrated with that of existing international organizations concerned with public health and statistics such as the Pan-American Sanitary Bureau and the Inter-American Statistical Institute.

1941: Vital Statistics

The various organizations responsible for vital statistics in the United States are loosely linked in a cooperative federal-state system. The offices of the state registrars of vital statistics are located in the state health departments with but one exception, Massachusetts, in which this office is placed under the control of the State Department. Four cities, Boston, New York, Baltimore and New Orleans, have vital statistics systems independent of state control. The District of Columbia is also independent and functions like a state in this respect. Transcripts of birth, death, marriage and divorce certificates are bought by the Bureau of the Census from the states. It is the states' responsibility to collect the original certificates, and also to ensure their accuracy, to provide safeguards against their loss or destruction, and to process them for statistical and other purposes.

National Defense and Vital Statistics.

The present system has never been strong enough in structure, personnel, funds or legal authority to meet adequately its regular functions and responsibilities. On this relatively weak system the national emergency has placed a tremendous burden. The state and city offices of vital statistics have been overwhelmed in all parts of the country by an unusual public demand for certified copies of birth certificates. This is due to the fact that national laws, and agencies responsible for their enforcement, are demanding proof of the facts of birth and citizenship.

It has been estimated that there are approximately 60,000,000 people in the United States who are unable to obtain a certified copy of a birth certificate so as to establish the facts of their birth. Since so many rights and privileges are dependent upon the proof of citizenship and the facts of birth, it was necessary to develop a method by which such proof could be assembled, inspected and made available for the use of persons not having a birth certificate on file. The Division of Vital Statistics, in cooperation with state registrars of vital statistics, developed a manual outlining a uniform procedure and setting general standards to be followed in the filing of delayed certificates of birth. This manual, published on July 21, 1941, was distributed to all state registration officials and other interested persons. The standards and procedures outlined in the manual were developed after a series of conferences with representatives of Federal agencies, state registrars, and state health officers. The procedures which are specified in it are now being adopted by a large number of states with the assurance that the Federal and state agencies which require proof of age or nationality will accept certificates in conformity with such minimum standards.

The importance of this problem and the general acceptance of the Bureau's procedures is evidenced by the fact that a letter issued by the Acting Secretaries of War and Navy to all contractors and subcontractors of national defense orders recommends that they adhere to the Manual of Uniform Procedure for the Delayed Registration of Births, as issued by the Bureau of the Census.

Publications.

Two annual volumes of Vital Statistics of the United States, one by place of occurrence and the other by place of residence, were published in 1940. In addition, several volumes of the Vital Statistics-Special Report series were released. One volume dealt with general subjects and another with state summaries. A special volume in the series summarized the facilities and services in hospitals and other institutions. Annual publications on the statistics of prisoners, and of patients in mental and defective institutions, were also released, as well as certain current series, i.e., Weekly Mortality Index, Motor Vehicle Accident Deaths, Monthly Vital Statistics Bulletin, and The Registrar.

Accident Statistics.

A new transcript has been developed by the Division for the collection of motor vehicle accident fatality statistics. In the use of this transcript the state registrar is requested to fill in material from the death certificate dealing with automobile fatalities. The state traffic authority then receives the transcript and makes up a supplementary report. By this process it has been possible to link information concerning fatalities due to automobile accidents with the exact knowledge as to where the accident occurred and what type of accident was involved. Practically all states are participating in this project. The data collected will be released in the form of quarterly reports entitled Summary of Motor Vehicle Accident Fatalities, and an annual summary for the country as a whole. The first of the quarterly reports was released late in 1941. (See also ACCIDENT PREVENTION.)

Monographs.

During the Census period the Division of Vital Statistics is undertaking the preparation of a number of monographic books and special studies. The following books are well along toward the point of completion:

(1) Studies on cardiac disease

(2) Results and problems of residence allocation of births and deaths

(3) Analysis of birth and death rates

(4) Comparability of mortality statistics

(5) Twenty-five years of birth registration in the United States

Birth Registration Test Project.

During the fiscal year 1941 the nation-wide test of the birth registration was begun. As a part of the 1940 decennial census a special infant card was made for each child under four months of age at the time of enumeration of the census schedule. These infant cards were matched with the birth certificates filed in state vital statistics offices for the same period. The project, when completed, will represent a very real accomplishment of the Division of Vital Statistics. For the first time in 25 years a simultaneous and consistent test of birth registration will have been made for every county of the country. Although the testing project is not yet complete, many deficiencies in the registration in certain states have been revealed.

Marriage and Divorce Statistics.

During the decennial census period the Division of Vital Statistics was authorized to collect and publish statistics relating to marriage and divorce. In developing this program for the collection and tabulation of marriage and divorce statistics, plans were made to collect much more than a mere count of these events. The collection of these data is almost complete, and detailed plans for tabulation and publication have been worked out. The Division hopes, in the future, to place marriage and divorce statistics on an annual basis. Registration areas of marriage and divorce have been established, to which states and municipalities will be admitted when registration of these vital facts is sufficiently complete and accurate.

Inter-American Statistical Activities.

In 1940 the Division responded to urgent requests from Uruguay to send one of its technical experts to that country in order to recommend improvements in its vital statistics system. The result of this loan of personnel for a period of approximately six months has been greatly appreciated. Similar requests are being received from other nations. Foreign students coming to this country on foundation fellowships are using the Division of Vital Statistics, to an increasing degree, as a place to visit and obtain practical experience. Divisional plans for the future, consequently, anticipate a considerable extension in the demand for this type of effort.

United States Summary of Vital Statistics in 1940.

There were 2,360,339 births and 1,417,269 deaths reported for the United States in 1940, an increase of 94,811 births and 29,372 deaths, as compared with the corresponding figures for the preceding year. The birth rate increased to 17.9 per 1,000 population in 1940 and was the highest recorded for the birth registration area since its completion in 1933. The death rate increased slightly to 10.8 per 1,000 population.

Although there was a slight increase in the total death rate, the trends of the maternal-death rate and infant-mortality rate continued on their downward path. The death rates for both of these causes were the lowest ever recorded for the birth registration area.

The rank order of the principal selected causes of death in 1940 did not change materially from that of 1939. The 1940 mortality experience continues to show the general effects of an ageing population and a decline in death rates for infectious diseases. In 1940 there were substantial increases in the death rates for diseases of the heart, cancer, intracranial lesions of vascular origin, and accidental causes of death, and decreases in the death rates for influenza and pneumonia, diarrhea and enteritis, and tuberculosis. See also PUBLIC HEALTH SERVICE: Morbidity and Mortality.

1940: Vital Statistics

The first collection of vital statistics data for the entire United States was made during the decennial census of 1850 when information on births and deaths was obtained. Since that time the system for collection of birth and death statistics has been modified from an enumeration to a registration procedure.

Official vital statistics in the United States Division of Vital Statistics have been, for the most part, limited to births and deaths but in 1939 the activities were expanded to include marriage and divorce data, statistics of patients in mental institutions, information relating to hospitals and hospital facilities, and criminal and judicial statistics.

Records of Births.

One of the notable features in the field of vital statistics in 1940 was the unprecedented public demand for legal proof of birth. This enormous increase in demand for copies of birth certificates came as a result of industrial mobilization in connection with the National Defense Program. The offices of the city and State bureaus of vital statistics were virtually swamped with requests for facts of personal identity, citizenship, and age from those employed or seeking employment in the defense industries. Never before in the history of the country have so many people felt the acute and vital need for proof of age and citizenship supplied by the birth certificate.

In conjunction with the 16th Decennial Census, a number of major projects were started in the U. S. Division of Vital Statistics in 1940. One of these projects relates to the testing of the completeness of birth registration by checking transcripts of birth certificates against the infant enumeration data from the 1940 Census. Other studies being conducted include (a) analysis of results and problems of residence allocation of births and deaths, (b) regional differences in mortality and natality, (c) study of the comparability of mortality statistics on the basis of the various decennial revisions of the International List of Causes of Death, (d) compilation and analysis of mortality and natality rates from 1900 to 1940, (e) statistical study of mortality from diseases of the heart, (f) a statistical critique of medical care in institutions, (g) population study of patients in mental institutions, (h) a critique of marriage and divorce statistics, and (i) differentials in judicial and penal treatment of offenders.

Birth and Death Rates.

According to the latest available natality and mortality statistics for the United States, there were 2,265,588 births and 1,387,897 deaths, a decrease of 21,374 in the number of births and an increase of 6,506 in the number of deaths as compared to the corresponding figures for the preceding year, 1938. On a rate basis, these data show that the birth rate declined from 17.6 per 1,000 estimated population in 1938 to 17.3 per 1,000 population in 1939. There was also a slight decrease in the death rate from 10.7 per 1,000 population in 1938 to 10.6 per 1,000 population in 1939.

The trends of the natality and mortality rates for the U. S. Registration Area show a rapid decline in the birth rate for the birth registration area from 1915 to 1933 when the downward trend in the birth rate was checked. Since 1933, the general trend in the birth rate appears to be in the upward direction but the increase during the period from 1933 to 1939 has been very slight. The death rate has been generally declining since the establishment of the U. S. Death Registration in 1900. The rate of decline, however, has been considerably less than that for birth rates. It is of interest to note that the death rate in 1939 was the lowest ever reported for the U. S. Death Registration Area.

Death Rates in United States by Causes.

The 10 principal causes of death (listed highest to lowest), diseases of the heart (excluding diseases of coronary arteries); cancers and other malignant tumors; nephritis; cerebral hemorrhage and softening; influenza and pneumonia (all forms); congenital malformation and diseases of early infancy; tuberculosis (all forms); diabetes mellitus; motor-vehicle accidents; and syphilis (all forms), accounted for about 68 percent of all the deaths in the United States in 1939. As in 1938, the most striking change to be noted in the comparison of specific mortality rates occurred in the death rate for influenza and pneumonia. The recent advances in and the wider application of pneumonia therapy appear to have been effective in lowering influenza and pneumonia from the third to the fifth leading cause of death in 1939. The other major changes in the rank order of the principal causes of death were the inclusion of syphilis in the place of suicide as the tenth leading cause of death and decline of tuberculosis from the sixth to the seventh position. Also affected by the changes in death rates in 1939 were diabetes mellitus and motor-vehicle accidents. There was a shift in the rank order of these causes due to the increase in the diabetes death rate and the slight decrease in the death rate for motor-vehicle accidents.

Comparison of Causes of Mortality.

It is of interest to note that influenza and pneumonia, and tuberculosis, which were the two leading causes of death in the U. S. Death Registration Area during the period, 1900-1910, are now occupying much lower positions in the rank order of the principal causes of death. The death rates for these causes in 1939 were the lowest in the history of the U. S. Death Registration Area. Equally significant are the increases in recent years in the death rates for the diseases of old age such as heart diseases, cancer, cerebral hemorrhage and softening of the brain, and nephritis. The death rate for cancers and other malignant tumors was, in 1930, the highest ever reported for the death registration area.

In regard to the other principal causes of death, the death rates show that there was a decrease in the death rate for heart diseases and an increase in the nephritis death rate in 1930. Part of these changes might be artifacts arising from the use for the first time of the fifth revision of the International List of Causes of Death.

Span of Life in Early Man.

See ANTHROPOLOGY.

1939: Vital Statistics

The scope of vital statistics is defined as the numerical registration, tabulation, and analysis of data dealing with population, marriages, divorces and diseases. Official vital statistics in the United States Division of Vital Statistics have been for the most part limited to births and deaths; but in 1939 the activities of the Division of Vital Statistics were expanded to include criminal and judicial statistics, marriage and divorce data, statistics of patients in mental institutions and more complete information relating to births and deaths in hospitals.

Birth and Death Rates.

The volumes published annually, 'Mortality Statistics' and 'Birth, Stillbirth and Infant Mortality Statistics,' have been revised. The data for 1937 appear in two new volumes, one containing vital statistics by place of occurrence and the other presenting the data by place of residence. The year 1939 also saw revisions of the International List of Causes of Death, the Manual of Joint Causes of Death and the Physician's Pocket Reference Manual. These publications represent noteworthy advances in the effort to place mortality statistics from various sources on a comparable basis. Extensive field work was also carried on during the year in order to secure and to maintain completeness in the registration of births and deaths and to improve the completeness and accuracy of the data recorded upon the original certificates.

In conjunction with the 16th Decennial Census, a number of major projects are planned. One of these projects is the testing of the completeness of birth registration by checking the transcripts against the census enumeration data. Other studies contemplated include (a) analysis of problems involved in residence allocation, (b) study of the international comparability of mortality statistics on the basis of the old and new International List of Causes of Death, and (c) special tabulations of certain important causes of death such as cancer, heart disease, maternal and infant mortality, tuberculosis, etc. It is also proposed to publish natality and mortality rates for the 20- or 40-year period ending with 1940. Special studies of occupational mortality and fatal accidents will also be conducted.

Death Rates in United States by Causes.

According to the latest available mortality statistics, the general death rate for the United States Registration Area appears to be continuing its downward progress. The death rate declined from 11.2 in 1937 to 10.6 per 1,000 population in 1938. The ten leading causes of death accounted for about 69 per cent of the total deaths in 1938. The most striking change to be noted in the comparison of specific mortality data for 1937 and 1938 occurs in the case of influenza and pneumonia. The death rate for influenza and pneumonia dropped from a rate of 114.5 deaths per 100,000 population in 1937 to 80.2 in 1938. How much of the sharp decline in the death rate from this cause is due to recent advances and wider application of pneumonia serum therapy is difficult to evaluate at present. Although tuberculosis still ranks sixth as a cause of death, the tuberculosis death rate for 1938 was the lowest ever recorded for the United States. The number of persons killed in motor-vehicle accidents in 1938 was 30,564, which is 6,641 fewer than the number reported for 1937. However, motor-vehicle accidents still constitute an important cause of death in the United States. (See also ACCIDENT PREVENTION.)

Comparative Mortality Rates by Causes.

The mortality experience of the United States as compared with that of Canada and certain European countries shows that the general death rate for the United States in 1936 was approximately the median rate for the group. In the interpretation of comparative mortality statistics, it should be kept in mind that certain differences in rates may result from variations in such factors as procedure employed in the assignment of the primary cause of death, completeness of reporting and registration, age and sex composition of the population, and certain other population characteristics. (See also CHILD WELFARE.)

Infant and Maternal Mortality Rates.

The infant mortality rate has been steadily declining in the United States Birth Registration Area since 1915. The infant death rate was 51.0 per 1,000 live births in 1938 as compared to 99.9 in 1915. The infant mortality rate for the previous year, 1937, was 54.4 per 1,000 live births. The maternal mortality rate was 4.5 per 1,000 live births in 1938 which is a slight decline from the 1937 rate of 4.9 deaths per 1,000 live births.

Trends of Birth and Death Rates.

The birth rate, in conjunction with the death rate, is a major factor in population growth. Although the trend of the total death rate of the United States has been slowly declining, the birth rate has also been falling. There was a steady downward trend in the birth rate during the period between 1915 and 1933. However, the decline appears to have been checked about 1934 and there have been only slight changes in recent years.