SERIES NO. 52DECEMBER 1998ORAL CANCER:

Deadly to IgnoreCancers of the oral cavity (lip, tongue, salivary glands, and other

sites in the mouth) and pharynx account for about 3% of the cancersdiagnosed in the United States each year. About 30,000 new casesare diagnosed and over 8,000 people die from the disease each year(1). The 1990-1994 mortality rate for oral cancers was 2.5 per100,000, ranking Oregon 37th among the states. Overall, the five-year survival rate for oral cancer is about 53%; however, minoritiesare much less likely than whites to survive after a diagnosis of oralcancer. Black males fare worse than any other group; only about 28%will survive five years after a diagnosis of oral cancer (3). Oral cancersare more likely to occur in men than in women and most often arediagnosed in people over the age of 40.

Early Detection

The oral cavity is an easilyaccessible part of the body, andexaminations for oral cancers canincrease the likelihood of detect-ing these life-threatening cancers.However, most oral cancers arenot detected at an early stage,when treatment is most effective.Although dentists are most likelyto perform an oral cancer exami-nation, all primary health careproviders, including physicians,nurses, and dental hygienists,should perform regular oral can-cer examinations for patients whohave been identified at high riskfor oral cancer (4,5).

SIGNS AND SYMPTOMS OFORAL CANCER

• A mouth sore that fails toheal or that bleeds easily.

• A white or red patch in themouth that will not goaway.

• A lump, thickening, orsoreness in the mouth,throat, or tongue.

• Difficulty chewing orswallowing food.

Prevention

Primary prevention strate-gies may offer the best opportu-nity for reducing oral cancerdeaths and disease. Health careproviders should counsel patientsabout the use of tobacco and al-cohol, high risk behaviors thatincrease the likelihood of devel-oping oral cancer (4,5). The useof tobacco is a contributing fac-tor in at least 75% of all oralcancers (4,6,7). Cigarettes havebeen established as a direct causeof oral cancer. There is strongevidence that snuff can cause oralcancer, and chewing tobacco in-creases the risk of tissue changesin the mouth that can lead to oralcancer. Among cigar and pipesmokers, oral cancer mortality

Inside:

Alzheim

er's

Diseas

e

Park

inson's

Diseas

e

OREGON HEALTH TRENDSPAGE 2 SERIES NO. 52

rates are similar to or higher thanamong cigarette smokers.

Avoidance of risk behaviorssuch as smoking, spit tobaccouse, and excessive alcohol drink-ing are critical in preventing oralcancers.

The deadly combination of�heavy drinking� and �heavy smok-ing� greatly increases the risk ofdeveloping oral cancer.

All forms of alcohol in excess(including beer, wine and liquor)can increase the risk of develop-ing oral cancer (4,7).

Risk Behaviors

Data from the 1995 Behav-ioral Risk Factor SurveillanceSystem (BRFSS), an on-goingtelephone survey of the adultpopulation, were analyzed for thisreport. The results indicate thatsignificant numbers of the popu-lation of Oregon are at risk of de-veloping oral cancer because ofrisk behaviors including tobaccoand alcohol use:� 507,162 adults in Oregon are

cigarette smokers.

� 82,441 men use smokelesstobacco.

� 132,189 Oregon adults smokecigarettes and use alcohol incombination.

� 41,081 adults at high risk fororal cancer because of cigaretteand alcohol use had no dentalor medical visit in the pastyear.

� In 1996, 379 cases of oralcancer were reported to theOregon Cancer Registry. Morethan twice as many males (259)were reported to the registry asfemales (120).

Tobacco

Among the adult popula-tion, 21.9% smoke cigarettes,compared to 22% nationwidein 1995. Of those adults cur-rently smoking 15.9 % smoke25 or more cigarettes each day.Adults ages 25-34 have theh ighest smoking ra tes inOregon whereas as a slightlyolder group, 35-44 year-oldshave the highest median rateof smoking for the UnitedStates.

In 1995, 3.6% of the adultmale population reported the useof smokeless tobacco.

Alcohol

About 14.4% of adults inOregon engaged in �risky drink-ing behaviors��consumingmore than 60 drinks per monthor consuming more than fivedrinks on at least one occasionduring the month. Youngeradults were more likely to reportrisky drinking behaviors thanolder adults.

In Oregon, about 5.7% ofadults are at increased risk oforal cancer because of combinedalcohol and tobacco use, com-pared to 5% nationwide.

Health Care Utilization

For adults at highest risk fororal cancer, access to health ser-vices is an important opportu-nity for early detection.According to data from the 1995BRFSS, in 1995, 63.7% of adults

Survival rates for oral cancer areamong the lowest of the major

cancers.

Snuff and chewing tobacco arenot safe substitutes for smoking

cigarettes.

PAGE 3OREGON HEALTH TRENDSDECEMBER 1998

reported that they had a routinemedical doctor visit during thepast year, and 70.8% reported adental visit. However, there wasunder- utilization among thoseat highest risk for oral cancer--smokers who engage in riskydrinking behavior. In Oregon,53.6% of those adults had nothad a routine medical doctorvisit within the past year, com-pared to 50% nationwide. About42.1% had not seen a dentistwithin the past year, and 31.5%had not had a routine medicalvisit or dental visit.

The two main reasons thatOregonians gave for not visitinga dentist within the last 12months were �no reason togo�(42.5%) [this was a predomi-nant reason for seniors with alltheir natural teeth removed] andcost (30.5%). As age rose the�no reason� category increasedfrom 21.4% to 83% for those 65and over. This fact should rein-force among medical doctors

The data in this fact sheet come from the Behavioral RiskFactor Surveillance System (BRFSS). The BRFSS is a con-tinuous telephone survey system supported in part by theCenters for Disease Control and Prevention and adminis-tered by the Oregon Health Division. The system is designedto provide information on behaviors and risk factors forchronic and infectious diseases and other health conditionsamong the adult population. The data for this report havebeen weighted to reflect the adult population of the state.Data for this newsletter were analyzed by the Division of OralHealth in the National Center for Chronic Disease Preventionand Health Promotion of the Centers for Disease Control andPrevention. Editorial support for this newsletter was pro-vided through a cooperative agreement with the Council ofState and Territorial Epidemiologists. Additional Oregon dataand program information was provided by the Oregon Cen-ter for Health Statistics and the Center for Health Promotionand Chronic Disease Prevention.

REFERENCES1. American Cancer Society. Cancer Facts and

Figures, 1997. Atlanta, GA: American CancerSociety, 1997.

2. Howe HL and Lehnherr M. (eds). Cancer inNorth America, 1989-1993, Volume One: In-cidence. Sacramento, CA: North AmericanAssociation of Central Cancer Registries, April1997.

3. Ries LAG, Kosary CL, Hankey BF, et al. (eds).SEER Cancer Statistics Review, 1973-1994,National Cancer Institute. NIH Pub. No. 97-2789. Bethesda, MD, 1997.

4. Centers for Disease Control and Prevention.Oral Cancer Background Papers. National Stra-tegic Planning Conference for the Preventionand Control of Oral and Pharyngeal Cancer.

5. US Preventive Services Task Force. Screeningfor Oral Cancer. In Guide to Clinical Preven-tive Services, 2nd Ed. Baltimore, MD: Will-iams and Wilkins, 1996.

6. US Department of Health and Human Services.Reducing the Health Consequences of Smok-ing. DHHS Publication No. (CDC) 89-8411,1989.

7. Silverman, S. Oral Cancer, 3rd Edition. At-lanta, GA: American Cancer Society, 1990.

8. National Center for Health Statistics. HealthyPeople 2000 Review, 1995-96. Hyattsville,MD: Public Health Service, 1996.

9. Proceedings: National Strategic Planning Con-ference for the Prevention and Control of Oraland Pharyngeal Cancer, August 7-9,1996. CDC:Atlanta, GA.

who treat older populations theneed to provide screening fororal cancers, as 76 % of those 65and older who haven�t seen theirdentist have seen their doctorwithin the last 12 months. Al-though 56% of the general popu-lation has dental insurance, only25 percent of seniors have den-tal insurance coverage.

Prevention

In August 1996, the Cen-ters for Disease Control and Pre-vention, in collaboration withother organizations, held a Con-ference concerning preventionof Oral and Pharyngeal Cancer.They recommended more pub-lic education so people wouldknow that an examination fororal cancer exists and that theycan and should request one rou-tinely from a variety of healthcare providers. The public alsoneeds to know the signs and

symptoms of oral cancer, therisk factors for the disease, andways to reduce risk. This is par-ticularly important for high-riskgroups of tobacco and alcoholusers.�

The recommended strate-gies for patient education in-clude:� counseling patients that

snuff and chewing tobaccoare not safe substitutionsfor smoking cigarettes.

� avoidance of risk behaviorssuch as smoking, spit to-bacco use, and excessivealcohol drinking are criticalin preventing oral can-cers.(9)

OREGON HEALTH TRENDSPAGE 4 SERIES NO. 52

ALZHEIMER�SPARKINSON�SDISEASE

This article focuses on two debilitating diseases that are affectinga growing number of Oregonians: Alzheimer's disease andParkinson's disease. Both are the subject of intense researchefforts, but as of now too often prove fatal. As our population ages,an increasing number of people will be at risk from thesedisorders. This article provides a brief overview of what is knownabout Alzheimer's and Parkinson's disease, including historicalmortality trends, risk factors, and the demographic characteris-tics of the decedents.

Alzheimer �s Disease

Year

Rat

e

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 950

5

10

15

20

Figure 1. Crude and Age-adjusted Death Ratesfor Alzheimer’s Disease, Oregon and the U.S., 1979-95

Rates are per 100,000 population.

OregonAge-adjusted

United StatesAge-adjusted

OregonCrude

United StatesCrude

Adjusted rates are standardized to the 1940 U.S. population.

Oregon has the third highestAlzheimer�s disease death rate inthe nation.1 Although the deathrate for this disease has risenmarkedly nationwide since 1979,the magnitude of the increase hasbeen larger in Oregon (Figure 1).2

The following briefly describesthe nature of Alzheimer�s disease3

and the demographic character-istics of people dying from thedisease.

WHAT IS ALZHEIMER’SDISEASE?

Alzheimer�s disease was firstdescribed in 1906 by the Germanneurologist Alois Alzheimer. Thedisease is characterized by the

Oregon’s Alzheimer’s diseaseage-adjusted death rate is 56%

higher than the nation’s.

Oregon’s Alzheimer’s diseaseage-adjusted death rate is

almost four times higher thanthat of New York’s, the state

with the lowest rate, 6.4 vs. 1.7.

PAGE 5OREGON HEALTH TRENDSDECEMBER 1998

destruction of brain cells result-ing in a decline in mental func-t ions that affects memory,language, motor skills, abstractthinking, sensory function, abil-ity to recognize objects, and be-havior. Anatomical changesinclude diffuse atrophy through-out the cerebral cortex with at-tendant, highly dist inctivepathological changes includingplaques and neurofibri l larytangles. The plaques are micro-scopic lesions made up of frag-mented axon terminals anddendrites enveloping a core ofbeta-amyloid protein. Neurofibril-lary tangles are intracellularclumps or knots of neurofibrilswithin individual diseased neu-rons.

The principal cognitive fea-ture of the disease is usually pro-gressive memory impairment. Inthe early stages of the disease,the person may forget smallthings, like a doctor�s appoint-ment or people�s names. As thedisease progresses, recall of re-

mote well-learned material mayappear to be preserved, but newinformation cannot be adequatelyincorporated into memory. Laterstages are marked by disorienta-tion and confusion; personalitychanges are commonly reportedand range from progressive pas-sivity to marked agitation. Insome cases, personality changesmay predate cognitive abnormal-ity. Depressive symptoms arepresent in up to 40 percent of thevictims, and psychosis occurs in25 percent. Ultimately, as brainfunction decreases, the ability totalk, move, and to provide self-care is eventually lost.

WHO DOES ALZHEIMER’SDISEASE AFFECT?

Although the disease can oc-cur in people in their 30s, moreoften it affects those 65 and older.The prevalence increases dra-matically with age, from about 3percent of people ages 65-74 to19 percent of those 75-84 to 47percent of those 85 or older. Atleast four million Americans are

Figure 2. Age-specific Alzheimer’s Disease Death Rates,by Age and Sex, Oregon Residents, 1996

Rat

e

45-54 55-64 65-74 75-79 80+0

100

200

300

400

500

600

0.50.50.5

1.62.32

22.625.824.4

105.1115.6111.1

447.5551.9515.1

MaleFemaleTotal

Male Female Total

2.0

Note: Rates are per 100,000 population.No deaths occurred before age 45.

Nationally, Alzheimer’s diseasedeath rates are highest in the

northern states; eight of the tenstates with the highest deathrates are located north of the

42 nd parallel.

The risk is greatest amongelderly females.

OREGON HEALTH TRENDSPAGE 6 SERIES NO. 52

estimated to have Alzheimer�s,and with increasing life spansand population, the number isexpected to increase to nearly15 million over the next fiftyyears. Already, the financial bur-den arising from the disease isabout $100 billion annually inthe U.S.; this includes the costof care and lost productivity. Butbeyond the economic costs, thehuman toll of Alzheimer�s im-mense, from the victims tocaregivers to society as a whole.

WHAT CAUSES ALZHEIMER’SDISEASE?

The underlying cause(s) ofthis disorder remains unclear thistime. However, a number of riskfactors have been identified in-cluding: age, female gender, ge-netic predisposition, certaincirculatory disorders, head inju-ries, deficiencies of antioxidantnutrients, family history of Downsyndrome, and environmentalfactors. Other factors have been

found to be associated with alower risk of Alzheimer�s disease,for example, more frequent useof nonsteroidal anti-inflamma-tory drugs and estrogen re-placement therapy (amongpostmenopausal women). How-ever, the possible role of thesefactors in the development ofthe disease is currently uncer-tain.

WHAT DO THE OREGON DATASHOW?

An Increasing Number ofDeaths. Since 1993, more than500 Oregonians have died an-nually from Alzheimer�s disease.Part of this increase is attribut-able to the aging of the popula-tion, but even after controllingfor this trend by calculating age-adjusted death rates, the rateshave risen inexorably for manyyears.4 Since 1979, the state�scrude death rate has increased43-fold while the age-adjusteddeath rate increased 16-fold.5 By

Figure 3. Age-adjusted Alzheimer’s Disease Death Rates,by County of Residence, Oregon, 1986-95

RATES

5.1 OR HIGHER

3.9 - 5.0

3.8 OR LESS

Note: Some rates are based on a small number of events.Rates are per 100,000 population.

Table 1.Crude and Age-adjusted Alzheimer’sDisease Death Rates1 by County of

Residence, 1986-95

County DeathsRates2

Age-adjusted3 Crude

Oregon 4,345 4.9 15.0

Baker 24 3.5 15.4Benton 83 5.8 11.7Clackamas 356 5.0 12.5Clatsop 65 5.6 19.3Columbia 40 3.6 10.5Coos 135 6.0 22.2

Crook 15 3.3 10.3Curry 35 3.9 18.2Deschutes 80 4.1 10.2Douglas 152 5.0 16.0Gilliam 2 4.0 11.4Grant 5 2.3 6.3

Harney 6 3.8 8.5Hood River 40 7.4 23.2Jackson 284 5.6 18.9Jefferson 7 2.4 5.0Josephine 243 8.7 37.6Klamath 120 6.8 20.6

Lake 1 0.5 1.4Lane 496 6.0 17.4Lincoln 54 3.4 13.6Linn 164 5.5 17.7Malheur 23 2.8 8.5Marion 288 3.5 12.3

Morrow 11 5.8 13.4Multnomah 871 4.5 14.7Polk 70 4.3 13.7Sherman 0 0.0 0.0Tillamook 55 7.0 25.0Umatilla 80 4.3 13.2

Union 32 4.2 13.4Wallowa 13 5.2 18.3Wasco 35 3.9 16.0Washington 362 4.7 11.3Wheeler 0 0.0 0.0Yamhill 98 4.9 14.61. Rates per 100,000 population.2. Rates based on fewer than 20 events areconsidered unreliable.3. Adjusted to the U.S. 1940 standardmillion.

PAGE 7OREGON HEALTH TRENDSDECEMBER 1998

comparison, rates for the UnitedStates have increased 30-foldand 14-fold, respectively. Dur-ing 1996, Alzheimer�s caused thedeaths of 743 Oregonians andcontributed to the deaths of an-other 536.

The degree to which the in-crease in Alzheimer�s mortalityis partially an artifact of improvedreporting is uncertain, but as di-agnostic procedures haveevolved, so too has the likeli-hood that more accurate diag-noses have contributed to theapparent increase in Alzheimer�s-caused deaths. Even so, physi-cians have continued to attributedeaths to �senility� and othersenile dementias; the age-ad-justed death rate for thesecauses rose more than three-fold during 1979-95.

Sex. Oregon females weretwice as l ikely to die ofAlzheimer�s disease than weremales; their death rate was 30.8per 100,000 population com-pared to 15.5 for males. The over-all rate was 23.3.

Age. Alzheimer�s deathsrarely occur before age 55. How-ever, by age 65, the death ratebegins to rise sharply with ad-vancing age. Oregonians 80 orolder were more than 20 timesas likely to die of the diseasethan were 65- to 74-year-olds(Figure 2).

County of Residence. Ofthe 12 counties with the highestAlzheimer�s disease age-ad-justed death rates during 1986-95, eight were west of theCascade Range.6 Great Basinand adjacent counties were no-table for their low death rates.

Oregonians Dying fromAlzheimer’s Disease

1979: 151996: 743

Figure 3 shows the countiessorted into three equal groupsby rate. The highest death ratewas recorded for JosephineCounty; it was 78 percent abovethe state�s rate (Table 1).Alzheimer�s disease death rateswere at least one-third higherthan the state�s rate in three othercounties as well: Hood River(51% higher), Tillamook (43%),and Klamath (39%).

WHAT TREATMENT ISAVAILABLE?

Unti l recently, nothingseemed to slow the inexorabledecline caused by Alzheimer�sdisease. However, during the1990s two drugs have been li-censed by the FDA for treatmentof the disorder: Aricept andCognex. These medications donot stop or reverse the progres-sion of Alzheimer�s disease, butthey do slow the decline in cog-nitive functioning. Many othertreatments are in development.

ENDNOTES

1. For the ten-year period 1986-95, Oregonhad the highest rate in the nation. In1995 it ranked third behind Montanaand Maine. (The most recent compara-tive national data are for 1995.)

2. In this article, reference to Alzheimer�sdisease (ICD-9 331.0) includes Alz-heimer�s dementia (ICD-9 290.1).

3. Much of the information (excludingOregon data) was drawn from fourinternet sites: http://www.health-center.com/english/brain/dementia/default.htm, http://csa.sara.nl/alzintro.html, http://www.ohioalzcenter.org/facts.htm, and http://www.alzheimers.com/

4. Unless otherwise stated, temporal andgeographic comparisons are based ondata from the Center for Disease Con-trol and Prevention�s WONDER sys-tem (http://wonder.cdc.gov); rates areadjusted to the 1940 U.S. standard mil-lion; the most recent available data arefor 1995. All other death data are fromthe Health Division�s mortality files.

5. Age-adjusted death rates control forvariation in the age distribution overtime and between different geographicentities. For example, Oregon�s popula-tion is slightly older than the nation�s,so its crude death rate could reason-ably be expected to be higher. The age-adjusted rate allows for comparison ofentities as if the population structureswere identical. Any differences in therates are a consequence of factors otherthan age.

6. Of Oregon�s 36 counties, 18 are located west of the Cascade Range.

RESOURCES

Alzheimer's AssociationNational Office

1-800-272-3900

Oregon Chapters

Portland 503-413-7115

Salem 503-371-7728

Corvallis 541-752-1012

Eugene 541-345-8392

OREGON HEALTH TRENDSPAGE 8 SERIES NO. 52

Parkinson's Disease

Oregon has the highestParkinson�s disease death rate inthe nation. Although the deathrate for this disease has risenmarkedly nationwide since 1979,the magnitude of the increase hasbeen larger in Oregon (Figure 1).The following briefly describesthe nature of the disease1 andthe demographic characteristicsof people dying from Parkinson�sdisease.

WHAT IS PARKINSON’SDISEASE?

First described by JamesParkinson in 1817, Parkinson�sdisease is a chronic progressivedisease of the nervous systemcharacterized by the deteriorationof neurons (a type of cell found inthe brain). Neurons producedopamine, a chemical �messen-ger� that helps the nervous sys-tem control muscle activity. Whenthese neurons are destroyed,

dopamine is not produced at thenormal rate, and the resultingabnormally low supply of dopam-ine causes Parkinson�s symptomsto appear. These include: stiff-ness, tremor, fixity of expression,slowness and poverty of move-ment, a shuffling gait, difficultywith balance, and difficulty walk-ing. Secondary symptoms ofParkinson�s disease may include:depression, senility, postural de-formity, and difficulty in speak-ing. Typical ly, the diseaseprogresses very slowly.

WHO DOES PARKINSON’SDISEASE AFFECT?

Most commonly diagnosedare people over the age of 60, butabout 10 percent are diagnosedbefore age 50. Nationally, 1.5 mil-lion Americans are thought tohave the illness, with another50,000 people being diagnosedannually.

Year

Rat

e

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 950

2

4

6

8

Figure 1. Crude and Age-adjusted Death Ratesfor Parkinson’s Disease, Oregon and the U.S., 1979-95

Rates are per 100,000 population.

OregonAge-adjusted

United StatesAge-adjusted

OregonCrude

United StatesCrude

Adjusted rates are standardized to the 1940 U.S. population.

Oregon’s Parkinson’s diseaseage-adjusted death rate is

63% higher than the nation’s.

PAGE 9OREGON HEALTH TRENDSDECEMBER 1998

WHAT CAUSES PARKINSON’SDISEASE?

The underlying cause of thisdisorder remains unclear thistime. There may be multiplecauses that share a final com-mon pathway resulting in Par-kinsonian symptoms. Someknown causes include certaindesigner drugs (e.g., MTMP), andan outbreak of a flu-like infec-tion during the first two decadesof this century. Areas under in-vestigation include: the environ-ment, toxins, infectious disease,accelerated aging, and geneticpredisposition.

WHAT DO THE OREGON DATASHOW?

An Increasing Number ofDeaths. Since 1995, more than200 Oregonians have died an-nually from Parkinson�s disease.Part of this increase is attribut-able to the aging of the popula-tion, but even after controllingfor this trend by calculating age-adjusted death rates, the death

rates have risen inexorably formany years.2 Since 1979, thestate�s crude death rate has in-creased 243 percent while the age-adjusted death rate increased 160percent.3 By comparison, rates forthe United States have increased156 percent and 78 percent, re-spectively.

Sex. Oregon males are 71percent more likely to die fromParkinson�s disease than arefemales; their death rate was9.4 per 100,000 population,compared to 5.5 for females (Table1).

Age. Parkinsonism deathsrarely occur before age 55. How-ever, by age 65, the death raterises sharply, particularly amongmales.

County of Residence. Al-though Parkinson�s diseaseage-adjusted death rates during1986-95, were more often lowerfor counties east of the CascadeRange4 (Figure 2), the highestdeath rate was for Wasco

Number of Oregonians Dyingfrom Parkinson’s Disease

1979: 551996: 232

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Nationally, Parkinson's diseasedeath rates are highest in the

Pacific Northwest, RockyMountain states, and

New England.

OREGON HEALTH TRENDSPAGE 10 SERIES NO. 52

County; it was 58 percent abovethe state�s rate (Table 2).4

Parkinson�s disease death rateswere at least 25 percent higherthan the state�s rate in two othercounties as well: Lane (37%higher), and Yamhill (26%).

WHAT TREATMENT ISAVAILABLE?

Although there is currentlyno cure for Parkinson�s disease,there are a number of palliativetreatments available, includinganticholinergics, amantadine, L-dopa, dopamine agonists, andcatechol-O-methyltransferaseinhibitors. There is also increas-ing potential for neurosurgicalintervention.5 Areas of recent re-search include the role of tauproteins, use of Sertoli cells (fromthe testes), adrenal medullarytransplants, fetal tissue trans-plants and gene therapy.

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Figure 2. Age-adjusted Parkinson’s Disease Death Rates,by County of Residence, Oregon, 1986-95

RATES

2.0 OR HIGHER

1.4 - 1.9

1.3 OR LESS

Note: Some rates are based on a small number of events.Rates are per 100,000 population.

ENDNOTES1 Much of the information (excluding Oregon

data) was drawn from two internet sites: http://neuro-chief-e.mgh.harvard.e...kinsonsweb/Main/IntroPD/Intro.html, and http://healthguide.com/PD/whatispd.htm.

2 Unless otherwise stated, over-time and geo-graphic comparisons are based on data fromthe Center for Disease Control andPrevention�s WONDER system (http://wonder.cdc.gov). Rates are adjusted to the1940 U.S. standard million; the most recentavailable data are for 1995. All other deathdata are from the Health Division�s mortalityfiles.

3 Age-adjusted death rates control for changesin the age distribution over time, and betweendifferent geographic entities. For example,Oregon�s population is slightly older than thenation�s, so its crude death rate could reason-ably be expected to be higher. The age-adjusted rate allows for comparison of entitiesas if the population structures were identical.Any differences in the rates are a consequenceof factors other than age.

4 Of Oregon�s 36 counties, 18 are locatedwest of the Cascade Range.

5 Plafer JR. Parkinson�s disease. Postgrad MedJ; 1997; 73:257-84.

RESOURCESNational Parkinson

Foundation 1-800-327-4545

National Parkinson's Disease Foundation1-800-457-6676

Willamette/Columbia Parkinson Society503-692-3192

PAGE 11OREGON HEALTH TRENDSDECEMBER 1998

It Comes for Us All

Leading Causes of Death, by Age,Oregon Residents, 1997 (Preliminary)

Cause Total < 1 1-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

TOTAL 28,678 255 151 352 468 963 1,686 2,528 5,380 8,886 8,008

Heart Disease 7,454 2 5 5 32 123 333 584 1,285 2,534 2,551

Cancer 6,756 1 18 14 55 184 535 1,001 1,921 2,086 941

Cerebrovascular Disease 2,568 3 - 2 7 25 58 90 346 913 1,124

COPD 1,630 - 1 2 5 5 37 130 459 674 317

Unintended Injury 1,296 8 64 194 160 211 164 70 95 151 179

Pneumonia & Flu 917 5 1 2 4 13 16 30 96 287 463

Diabetes 805 - - 2 8 12 59 85 202 277 160

Alzheimer’sDisease/Dementia 714 - - - - 1 - 5 42 249 417

Suicide 533 - 7 60 84 107 105 55 47 53 15

Other Diseases of theArteries 363 - - 2 2 2 13 38 78 139 89

Alcoholic Diseases 359 - - 2 10 52 86 94 77 35 3

Arteriolsclerosis 234 - - - - - - 9 30 72 123

Hypertension 221 - - - - 1 6 13 31 77 93

Parkinson’s Disease 213 - - - - - - 2 29 105 77

Nephritis/Nephrosis 186 1 - - 2 6 7 13 27 62 68

Congenital Anomalies 170 66 11 7 7 9 8 11 14 26 12

Homicide 131 2 13 24 28 30 15 10 6 2 -

Septicemia 109 1 - - 1 4 6 9 25 37 26

Perinatal Conditions 102 99 2 1 - - - - - - -

AIDS 80 - - 2 21 32 18 5 2 - -

Other 3,837 68 29 33 42 146 220 274 568 1,107 1,350

trends were the increasing diabetes and Alzheimer�sdisease death rates; for a decade or more, both haveshown nearly inexorable increases, with a near dou-bling of rates for both diseases since 1987. At thesame time, the total Oregon death rate has shownrelatively little change (<1%).

The table below is a preliminary tabulation of thedeaths of Oregon residents during 1997. The numberof deaths among Oregonians declined last year by 222to 28,678. Most notable was the decline in the num-ber of residents dying from AIDS; the number fell byalmost two-thirds, from 223 to 80. Notable continuing

OREGON HEALTH TRENDSPAGE 12 SERIES NO. 52

OREGON HEALTHTRENDS is

published by theCenter for Health

Statistics

Send comments, questions and address changesATTN CDP&E or phone (503) 731-4354.Material contained in this publication is in thepublic domain and may be reproducedwithout special permission. Please creditOREGON HEALTH TRENDS, Oregon Health Division.

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Everybody dies eventually, but the timing and causes ofdeath vary. These differences reflect changes in sanita-tion, behaviors, history, social structures, medical knowl-edge, the availability of health care, and everything else.

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Below are rankings of the causes of death from differenteras, localities, and ethnicities; can you match themwith the following? Choose from:

A. London, 1632 D. Oregon, 1940B. Boston, 1810-20 E. Oregon, 1970C. Oregon, 1904-06 F. Oregon Hispanics, 1997

The Way of All Flesh

Answers: 1. D, 2. B, 3. F, 4. A, 5. E, 6. C