Causes of death contributing to changes in life expectancy in New York City between 1983 and 1992

Recent changes in life expectancy among race and sex groups in New York City were evaluated by analyzing the relative effects of different causes of death in 1983 and 1992, a period in which life expectancy at birth declined by 1.1 years among white males, remained unchanged among black males, and increased 1.2 years among white and black females. Heart disease was found to be the leading cause of death making positive contributions to changes in life expectancy regardless of race or sex, and HIV/AIDS was the leading negative contributor. Overall, deaths from infectious diseases and external causes are becoming more important compared to degenerative conditions in explaining trends in life expectancy in New York City. Past improvements in survival due to reductions in infant deaths are being reversed due to an increase in deaths from preventable causes such as violence and AIDS. Future gains in longevity may require a greater emphasis on policies and programs emphasizing conflict resolution and HIV prevention.     

Evolution of an urban epidemic: The first 100,000 AIDS cases in New York City

Between 1981 and August 1997, 100,000 AIDS cases were reported in New York City (NYC): 77,067 men, 20,818 women, 307 teenagers, and 1,808 children. This report examines AIDS trends in NYC as the epidemic evolved from a predominantly white male epidemic among men with same sex contact (MSM) mostly from a single borough to a geographically diffuse epidemic that includes injecting drug users (IDU), persons of color, and women infected heterosexually. Case data were collected by active surveillance methods augmented by electronic laboratory based reporting. Mortality data were obtained from NYC Vital Statistics. 1990 Census data were used to derive incidence rates and prevalence by neighborhood income. Rates per 100,000 adults by neighborhood ranged from 260 to 5,500. Total AIDS incidence peaked in 1993 and has subsequently declined. Among men there was a shift from MSM to IDU as the predominant risk group, and increasing incidence among men reporting heterosexual contact. IDU was the leading risk factor among women, and women increased from 8 to 30 percent of all cases between 1982 and 1997. Unlike incidence, AIDS prevalence is rising among socially and economically marginalized populations, and will remain a major public health challenge well into the next century.