Deaths From Leading Causes Continue to Decrease in US

Susan London

October 28, 2015

Age-standardized mortality for all causes of death in the United States fell during a recent 44-year period, according to a nationwide population-based study published in the October 27 issue of JAMA. Rates declined for five of the six leading causes of death as well, likely reflecting better control of hypertension, hyperlipidemia, and smoking, as well as advances in medical therapy and motor vehicle safety.

In the study, Jiemin Ma, PhD, MHS, from the Surveillance and Health Services Research Program, Intramural Research Department, American Cancer Society, Atlanta, Georgia, and colleagues analyzed US national vital statistics data from 1969 through 2013 to assess temporal trends in mortality. They calculated the total change and annual percentage change in age-standardized death rates and in years of potential life lost before the age of 75 years for all causes combined and for the six leading causes: heart disease, cancer, chronic obstructive pulmonary disease (COPD), stroke, unintentional injuries, and diabetes.

Results showed that age-standardized mortality for all causes of death combined fell by 42.9% (95% confidence interval [CI], 42.8% - 43.0%), going from 1278.8 to 729.8 per 100,000, corresponding to an average annual decrease of 1.3%. This was driven by a 77.0% (95% CI, 76.9% - 77.2%) reduction for stroke, 67.5% for heart disease (95% CI, 67.4% - 67.6%), 39.8% for unintentional injuries (95% CI, 39.3% - 40.3%), 17.9% for cancer (95% CI, 17.5% - 18.2%), and 16.5% for diabetes (95% CI, 15.4% - 17.5%).

In contrast, the death rate for COPD increased by 100.6% (95% CI, 98.2% - 103.1%).

In addition, joinpoint regression analysis suggested the declines in rates for heart disease, stroke, and diabetes slowed toward the end of the study period; for example, the annual decline for heart disease fell from 3.9% (95% CI, 3.5% - 4.2%) during 2000 to 2010 to −1.4% (95% CI, −3.4% to 0.6%) during 2010 to 2013. The death rate for COPD in men began to decrease slightly in the 2000 to 2010 period but continued to increase in women.

Results further showed that the age-standardized years of potential life lost, reflecting premature deaths, fell by 52.4% for all causes of death combined (95% CI, 52.2% - 52.6%), going from 134.7 to 64.1 per 1000, corresponding to an average annual decrease of 1.7% (95% CI, 1.5% - 2.0%). This was driven by a reduction in rates of 14.5% for diabetes (95% CI, 12.6% - 16.4%), 40.6% for cancer (95% CI, 40.2% - 41.1%), 47.5% for unintentional injuries (95% CI, 47.0% - 48.0%), 68.3% for heart disease (95% CI, 68.1% - 68.5%), and 74.8% for stroke (95% CI, 74.4% - 75.3%). There was no reduction in this measure for COPD.

The new data provide an encouraging update to a similar previous study spanning 1970 through 2002, the investigators say. That study also found reductions in age-standardized death rates for all causes combined and for heart disease, stroke, cancer, and injuries individually; however, it found increases in the rates for COPD and diabetes.

"We are making progress in reducing death rates from all causes and from most leading causes of death," coinvestigator Ahmedin Jemal, DVM, PhD, also from the Surveillance and Health Services Research Program, commented in an accompanying audio statement. "However, rates during the most recent time period have slowed for heart disease, stroke, and diabetes, which is likely due to the obesity epidemic that has unfolded over the past 3 decades. We as health providers can do more to prevent and manage obesity through exercise, diet, and therapy for weight loss."

"The next step would be to find out why death rates for heart disease, stroke, and diabetes are slowing," Dr Jemal said. "One in five US adults are smokers; one in three are obese. And obesity, smoking, unhealthy diet, and physical inactivity account for almost half of the deaths in the US. We also need to invest more in research to discover new prevention, early detection, and treatment in order to accelerate the reduction in mortality."

J. Michael McGinnis, MD, MPP, from the National Academy of Medicine, Washington DC, commends the study and the new insights it provides in an accompanying editorial. However, he notes, the available data did not permit similar analysis of trends in "rapidly emerging challenges," such as Alzheimer disease and suicide, nor did they enable assessment of the substantial effects of healthcare disparities.

"Death rate may have at one time served as a sufficient measure of health system performance, but assessment now requires more textured insights, including those that reflect the improving capacity to measure health status, risk prevalence, and service access, effectiveness, and affordability," he writes.

"[W]hat is needed is a set of national vital health indicators that is broader than mortality, but still a limited number, tightly constructed, standardized, and reliably available at all levels from local to national," he says, pointing to a set of 15 core measures recently endorsed by the Institute of Medicine. "Whether through adoption of this or some other expanded notion of what should constitute the nation's truly vital signs, the time has arrived to match the capacity with the potential and the need," Dr McGinnis says.

The authors and Dr McGinnis have disclosed no relevant financial relationships.

JAMA. 2015;314:1699-1700, 1731-1739. Article full text, Editorial extract

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