Increasing US Mortality From Infectious Diseases - Reply

Our recent analysis of death certificate data showed that the death rate from infectious diseases increased 58% in the United States between 1980 and 1992. We share Dr Randall's reservations about the quality of death certificate data, but we also agree with him that the conclusion that infectious disease mortality has been increasing recently in this country is inescapable. We focused on underlying cause-of-death data to present a conservative estimate of the burden of infectious disease, though infectious diseases often contribute to deaths even when they are not designated as the underlying cause. The HIV epidemic provides the most apparent contribution to recent increases in mortality from infectious diseases. Further, the fact that both underlying and multiple cause-of-death data showed comparable upward trends is also evidence that the increasing death rate from infectious diseases is not merely an artifact of changes in the way death certificates are completed.