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"If you're looking at how many different ways there are to killing yourself or dying," muses Lorenzo-Luaces, "there are probably an infinite number of ways." Perhaps. But HRS has, in its infinite administrative wisdom, designed a rigid classification system that assigns each fatality to one of 68 cause-of-death categories, which are further broken down into 360 categories. "The 360-cause-group listing is very detailed. Are you sure you want that listing?" asks a helpful Lorenzo-Luaces, an anomaly the HRS Bureaucratic Mean Police haven't yet ferreted out. "We use the 68-causes-of-death listing because it's a lot easier to work with. It's a condensed version, and we can pick our ten leading causes of death from it."
And indeed, the 360-cause-group listing is much more specific than its simpler-minded relative, the 68-cause-group listing. "Maternal causes" on the short list becomes a dozen separate causes on the longer list, including "legally induced abortion" and "indirect obstetric causes." But you're out of luck if you died of some esoteric accidental cause - say, bleeding to death after being sliced by a Cuisinart blade while preparing quiche Lorraine - and hoped for an equally exotic cause group. The best you could expect is to be filed under "Accident: Machinery."
"Vital Statistics is inherently inaccurate, based on a number of things," says Chief Medical Examiner Davis. "One is the coding rule that [HRS] can only include one cause of death. But when you have a multifactoral death causation, many of those factors are left out." By way of example, Davis imagines a drug-induced brain hemorrhage. "The `natural' cause - bleeding - would be listed in part one of the death certificate, and the `contributory' cause - drugs - would be listed in part two," says Davis. "The Office of Vital Statistics would pick only the first one, and here we are dealing with two causes working in concert." However HRS isn't the only party to blame for the misleading statistics. According to Davis, many doctors - precisely those people who are authorized to declare the end of a life - don't have a clue how to code or report deaths properly.
Despite their inaccuracy, the HRS stats are widely used in the public health industry. They inform the planning of medical facilities, help insurance agencies derive actuarial tables, and highlight general health and disease patterns. "They are used by people that want to know, generally, where the problems are," Davis explains. "In the long run, the inaccuracies tend to smooth out when you get into bigger numbers. If you don't try to make the diagnoses too specific, the numbers can be very useful. If you try to draw too much specific data, then you get into trouble."
The concepts of public health care and statistics have developed simultaneously; both trace their genesis to the Middle Ages. "The public-health concept began with the prevention of the spread of plagues," says Davis. "Part of prevention was the documentation of what was going on. With AIDS, we're right back where we were with the great plagues. We don't know what to do about it. We don't know where it came from. The least we can do is document it."
And Dade County provides plenty of documentable AIDS activity. According to HRS statistics, the human immunodeficiency virus (HIV) is more active in Dade than anywhere else in the state. In 1990, about a third (710) of Florida's total HIV-related deaths occurred in Dade. The bulk of the county's AIDS victims, as in other major urban areas around the nation, are between the ages of 25 and 64, with a majority in their 30s and early 40s. More than half are white males, about a third are black men, and most of the remainder are black women.
Dr. Margaret Fischl, director of the Comprehensive AIDS Program at the University of Miami, attributes the county's high HIV rate in part to the city's multiethnic composition and the regular flow of people to and from foreign countries. And because the principal mode of HIV transmission overseas is between heterosexuals, the virus has infiltrated the Dade heterosexual population in extraordinarily high numbers. In fact, according to a national study in 1990, Dade County has the second-highest rate of heterosexually transmitted HIV cases in the U.S., as well as one of the highest general HIV rates.
However, Fischl doubts heterosexuals, by and large, will grasp the wisdom in the statistics and change their sexual habits anytime soon. "I don't think heterosexuals think they're at risk yet," she says. "We're seeing men and women who are sexually active and have no idea they're at risk." Fearless heterosexuals, Fischl says, generally have a greater number of sexual partners and avoid condoms as most people would goldfish consumption. As a result, public health officials expect Dade's AIDS rates to skyrocket during the next decade.
While AIDS might provide the most obvious and headline-grabbing example, Dade's entire hit parade of fatality reveals that how we live is how we die. Throughout the HRS statistical breakdown, the quartet of cigarettes, alcohol, drugs, and a poor diet wreaks its havoc:
* Tobacco almost entirely accounts for the chronic obstructive-lung-disease deaths (592 in 1990), Davis says, and contributes in part to the heart-disease and cancer statistics.