During the early twentieth century the declining mortality rates from infectious diseases brought chronic diseases to greater public attention. The history of rheumatic heart disease, then a major chronic disease, demonstrated the many difficulties involved in their management and control.

Mortality Trends in the Early Twentieth Century

Between 1900 and 1940 overall mortality rates declined more than in any comparable period in American history, but the amounts varied widely among age and sex groups. This is indicated by vital statistics from 1900 to 1940 for those states that were included in the death registration area since its inception in 1900 (see Table 10.1). These states, primarily in the North east and Midwest, had the most trustworthy reporting and comprised about one-fourth of the total United States population. Their mortality rates declined by about 90% for children ages 1–4 and by more than 50% for males and females through ages 35–44. The oldest age groups had much smaller reductions. Women ages 54–65 experienced a 25% decline in their mortality rates and those 65–74 experienced a 15% decline. Men ages 55– 64 and 65–74 experienced a 10% decline over the four decades, but practically no decline after 1920. For all practical purposes, the great mortality decline excluded men ages 55 and older.

The best statistics on mortality trends in urban areas are those of the industrial policyholders of the Metropolitan Life Insurance Company. The number of policyholders was enormous: between 1879 and 1929 the Metropolitan sold 100 million industrial policies and in 1929 it had 19 million industrial policyholders. The policyholders were overwhelmingly urban, with only 5% of deceased male industrial policyholders ages 15 and over employed in agriculture compared to 25% of all deceased occupied males in the death registration area.