In 2003, HHS Secretary Tommy Thompson approved the revision to the U.S. Standard Certificates of Death and Fetal Death and encouraged all states to adopt them. The process involved in this revision, as well as details of what was revised, can be found at the National Vital Statistics System web site 2003 Revisions of the U.S. Standard Certificates of Live Birth and Death and the Fetal Death Report.
Texas adopted the new U.S. Standard Certificates of Death and Fetal Death in 2006. This revision includes changes to items such as alcohol use, race/ethnicity, etc. For details regarding race/ethnicity computation, see Table 44.
A total of 183,303 Texas residents died in 2014. The leading cause of death, diseases of the heart, accounted for 22.5 percent of those deaths, while the second most common cause of death, malignant neoplasms (cancer), accounted for 21.1 percent. Cerebrovascular disease, chronic lower respiratory diseases, and accidents ranked third, fourth, and fifth, respectively. Together, these five leading causes of death represented 59.5 percent of all deaths in 2014.
The number of infant deaths increased to 2,320 deaths in 2014 compared to 2,253 deaths in 2013. The infant mortality rate remained at 5.8 infant deaths per 1,000 live births. Fetal deaths increased from 2,092 in 2013 to 2,200 in 2014. The fetal death ratio increased to 5.5 fetal deaths per 1,000 live births in 2014 compared to 5.4 in 2013. A total of 139 women died in 2014 as a result of pregnancy or childbearing for a maternal mortality rate of 34.8 maternal deaths per 100,000 live births.
Years of potential life lost (YPLL), a measure of premature mortality, is the sum of years lost by persons who die before age 65 (see Technical Appendix). The YPLL by Texans increased from 909,027 in 2013 to 932,276 in 2014. Accidents, malignant neoplasms, and diseases of the heart continued to be the top three causes of premature mortality in Texas.
Leading Causes of Death
The order of the top three leading causes of death had remained the same between 1979 and 2006. Diseases of the heart claimed 41,293 lives (40,150 in 2013) and continued to be the leading cause of death followed by malignant neoplasms (cancer) with 38,727 deaths (38,289 in 2013). Diseases of the heart and malignant neoplasms have been the first and second leading causes of death in Texas and the nation since 1950.
Since 2007, the third, fourth, and fifth leading causes of death have changed every year. Cerebrovascular disease, chronic lower respiratory disease, and accidents were the third, fourth, and fifth leading causes of death in 2014. Cerebrovascular disease moved up from fifth rank in 2013 to third in 2014 with 9,852 deaths (9,238 in 2013). Chronic lower respiratory disease dropped from third rank in 2013 (9,787 deaths) to fourth rank in 2014 (9,642 deaths). Accidents dropped from fourth rank in 2013 to fifth rank in 2014 with 9,598 deaths (9,341 in 2013). The top three leading causes of death, diseases of the heart, malignant neoplasms, and cerebrovascular disease, accounted for 49 percent of all Texas resident deaths in 2014. The next two leading causes of death, chronic lower respiratory diseases and accidents, accounted for another 10.5 percent of all Texas resident deaths in 2014.
The sixth leading cause was Alzheimer's disease with 6,755 deaths in 2014 (5,284 in 2013) and diabetes mellitus was the seventh leading cause in 2014 with 5,327 deaths (5,262 in 2013). Septicemia was the eighth leading cause with 4,102 deaths in 2014. Nephritis and related diseases were the ninth leading cause with 3,997 deaths. Finally, chronic liver disease and cirrhosis were the tenth leading cause with 3,663 deaths in 2014.
The top ten causes of death varied slightly when broken down by race/ethnicity. Although suicide is no longer one of the ten leading causes of death among all Texas residents, it is the ninth leading cause in the White/Other race/ethnicity category. For the Black race/ethnicity category, homicide ranked tenth among leading causes of death (see Table 16 for the leading causes of death by race/ethnicity), down from ninth in 2013. For details regarding race/ethnicity computation, see Table 44.
The majority of deaths (29.4 percent) in 2014 to residents ages 1 through 44 were due to accidents. Suicides were responsible for 11.7 percent of all deaths to this age group and malignant neoplasms claimed the lives of another 11.3 percent.
Beginning at age 45, accidents play a less significant role in total deaths; only 10.1 percent of all deaths to individuals 45-54 were due to accidents. However, malignant neoplasms and diseases of the heart were responsible for 44.4 percent of the deaths to this age group. Deaths due to chronic conditions (diseases of the heart, malignant neoplasms, chronic lower respiratory diseases, cerebrovascular diseases, and Alzheimer's disease) were the major causes of death in individuals 55 years and older, accounting for 62.6 percent of deaths to this age group.
Although males represented 49.7 percent of the Texas population in 2014, they accounted for 60.2 percent of all deaths to persons 1 through 74 years of age. In 2014, the mortality rate for diseases of the heart was 93.2 per 100,000 males and 48.3 per 100,000 females in the 1-74 age group. External causes (such as accidents, homicide, and suicide) also contributed to the gender difference in mortality. Males were more likely than females to die at younger ages from these causes (see Table 17).
Enterocolitis due to Clostridium difficile is an antibiotic-associated intestinal inflammation caused by C. difficile bacteria. It has become a growing cause for concern throughout the United States and is included in the National Center for Health Statistics annual reports. Like the rest of the United States, Texas has seen an increase in deaths due to C. difficile over the past decade. In 2014, there were 367 deaths in Texas due to C. difficile related enterocolitis, compared to 295 in 2010 and 172 in 2005. Of those 367 deaths, 325 (88.6%) occurred among people aged 65 and over.
There were 2,320 infant deaths to Texas residents in 2014 for an infant mortality rate of 5.8 infant deaths per 1,000 live births (see Table 29). The Black infant mortality rate (11.1) continued to be considerably higher than the rate of Whites (4.9) and Hispanics (5.4).
The top five leading causes of infant death in 2014 were congenital malformations, deformations, and chromosomal abnormalities (23.4 percent of all infant deaths); disorders related to short gestation and low birth weight, not elsewhere classified (15.6 percent of all infant deaths); Sudden Infant Death Syndrome (8.1 percent); newborns affected by maternal complications of pregnancy (7.9 percent); and unintentional injuries (4.1). For selected causes of infant death among Texas residents (non-ranked), see Table 31.
The majority (1,539; 66.3 percent) of infant deaths took place during the first 27 days of life (neonatal period), and the rate of neonatal deaths in Texas was 3.9 per 1,000 live births (see Table 30). By rank, the top leading causes of neonatal death were congenital malformations, deformations, and chromosomal abnormalities (25.5 percent) and disorders related to short gestation and low birth weight, not elsewhere classified (19.2 percent). For selected causes of neonatal death among Texas residents (non-ranked), see Table 32.
Fetal Deaths and Perinatal Mortality
A fetal death is the death of a product of conception before complete expulsion or extraction from its mother. In Texas, it is required to be registered with the Vital Statistics Unit as a fetal death for any fetus weighing 350 grams or more, or if the weight is unknown, a fetus aged 20 weeks or more. However, all reported fetal deaths, regardless of weight or length of gestation, are included in this summary table. There were 2,200 fetal deaths to Texas residents in 2014. The fetal death ratio was 5.5 fetal deaths per 1,000 live births in 2014, which is greater than in 2013 (5.4).
Perinatal mortality includes fetal and neonatal deaths. The perinatal mortality rate was 8.9 per 1,000 fetal deaths and live births in 2014 (8.8 in 2013). For calculating perinatal mortality rate, only fetal deaths that are 20 or more weeks gestation are included (see Table 28).
In the Texas Vital Statistics Annual Reports, maternal deaths are reported as the number of deaths due to pregnancy, childbirth, the puerperium up to six weeks post-delivery, and any obstetric cause from 42 days to a year post-delivery and its sequelae (ICD-10 codes O00-O99). In 2014, 139 women died as a result of pregnancy or childbearing for a maternal mortality rate of 34.8 per 100,000 live births. The maternal mortality rate for Black women of 71.8 is lower in 2014 than it was in 2013 (88.4) and continues to be higher than the state value. The maternal mortality rate for White (excluding Other) women decreased from 43.6 in 2013 to 40.1 in 2014. Among Hispanic women, the maternal mortality rate decreased from 27.5 in 2013 to 25.9 in 2014. However, rates based on small numbers may be misleading (see Technical Appendix).
Life Expectancy at Birth
Texans born in 2014 had a life expectancy at birth of 78.2 years. Because males tend to die from more external causes (such as accidents, homicide, and suicide) and at younger ages than females, females had a higher life expectancy at birth than males: 80.7 years vs. 75.8. A Hispanic child born in 2014 had a life expectancy at birth of 79.5 years, while a White newborn had a life expectancy of 78.2 years. Black life expectancy remained below the average, at 74.8 years (see Table 25).
Age-Adjusted Death Rate
The age-adjusted death rate for Texas in 2014 was 766.2 deaths per 100,000 population. The age-adjusted death rate for males was 873.2 in 2014 and the rate for females was 672.9. The age-adjusted death rate for Whites and Others, regardless of gender, was 792.8 deaths per 100,000 population. The Hispanic rate of 627.8 remained the lowest of all racial/ethnic groups in 2014. The age-adjusted death rate for Blacks continued to be well above the rate for the Texas population as a whole at 922.3 per 100,000 population (see Table 26A).
Years of Potential Life Lost (YPLL)
The YPLL statistic is a way to demonstrate both gender and race/ethnicity differences in mortality risks and is the sum of years lost by persons who die before the age of 65 (see Years of Potential Life Lost - Technical Appendix). The total YPLL for Texans in 2014 was 932,276 years, up from 909,027 years in 2013 (see Table 27). Male mortality accounted for 586,728 or 62.9 percent of these years and the total YPLL for women was 345,548 or 37.1 percent. This difference is mostly due to males dying at younger ages than females from causes that are primarily external or preventable in nature, such as accidents and HIV infection.
Death by accident was the number one cause of premature mortality in 2014 and represented 178,178 YPLL, or 7.5 years per 1,000 persons ages 0-64. Malignant neoplasms were responsible for the second largest number of years lost with 133,208 YPLL, for a rate of 5.6. Diseases of the heart had a rate of 4.6 and remained the third leading cause of YPLL in Texas, with 109,792 years of potential life lost. Certain conditions originating in the perinatal period was the fourth leading cause of premature mortality with 71,764 YPLL, with a rate of 3.0. The number of years lost from suicide and homicide were the fifth and seventh leading cause of premature mortality in Texas with YPLLs of 67,277 and 41,700 respectively (or 2.8 and 1.7 years per 1,000 persons ages 0-64 respectively). The number of years lost from congenital malformations remained sixth in 2014 from 2013 (42,551). Years lost from congenital malformations were 44,044 with a rate of 1.8.
*Information and statistics on maternal mortality and morbidity in Texas can be found on the DSHS Maternal and Child Health section website: DSHS Maternal and Child Health.