Trends in the leading causes of death in the United States, 1970-2002.

CONTEXT The decrease in overall death rates in the United States may mask changes in death rates from specific conditions. OBJECTIVE To examine temporal trends in the age-standardized death rates and in the number of deaths from the 6 leading causes of death in the United States. DESIGN AND SETTING Analyses of vital statistics data on mortality in the United States from 1970 to 2002. MAIN OUTCOME MEASURE The age-standardized death rate and number of deaths (coded as underlying cause) from each of the 6 leading causes of death: heart disease, stroke, cancer, chronic obstructive pulmonary disease, accidents (ie, related to transportation [motor vehicle, other land vehicles, and water, air, and space] and not related to transportation [falls, fire, and accidental posioning]), and diabetes mellitus. RESULTS The age-standardized death rate (per 100,000 per year) from all causes combined decreased from 1242 in 1970 to 845 in 2002. The largest percentage decreases were in death rates from stroke (63%), heart disease (52%), and accidents (41%). The largest absolute decreases in death rates were from heart disease (262 deaths per 100,000), stroke (96 deaths per 100,000), and accidents (26 deaths per 100,000).The death rate from all types of cancer combined increased between 1970 and 1990 and then decreased through 2002, yielding a net decline of 2.7%. In contrast, death rates doubled from chronic obstructive pulmonary disease over the entire time interval and increased by 45% for diabetes since 1987. Despite decreases in age-standardized death rates from 4 of the 6 leading causes of death, the absolute number of deaths from these conditions continues to increase, although these deaths occur at older ages. CONCLUSIONS The absolute number of deaths and age at death continue to increase in the United States. These temporal trends have major implications for health care and health care costs in an aging population.

[1]  E. Feuer,et al.  Permutation tests for joinpoint regression with applications to cancer rates. , 2000, Statistics in medicine.

[2]  K. Thorpe,et al.  The rising prevalence of treated disease: effects on private health insurance spending. , 2005, Health affairs.

[3]  H M Rosenberg,et al.  Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. , 2001, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[4]  Ruth A. Shults,et al.  Impact of primary laws on adult use of safety belts--United States, 2002. , 2004, MMWR. Morbidity and mortality weekly report.

[5]  Hyune-Ju Kim,et al.  Kim H-J, Fay MP, Feuer EJ, Midthune DN, ‘ Permutation tests for joinpoint regression with applications to cancer rates’. Statistics in Medicine 2000 19:335–351 , 2001 .

[6]  A. Jemal,et al.  Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival , 2004, Cancer.

[7]  A C Wagenaar,et al.  Effects of mandating seatbelt use: a series of surveys on compliance in Michigan. , 1986, Public health reports.

[8]  S. Garber,et al.  The effects of the new 65 mile-per-hour speed limit on rural highway fatalities: a state-by-state analysis. , 1990, Accident; analysis and prevention.

[9]  J Tuomilehto,et al.  International trends in mortality from stroke, 1968 to 1994. , 2000, Stroke.

[10]  Deborah Schrag,et al.  Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. , 2005, Journal of the National Cancer Institute.

[11]  D. Mannino,et al.  Chronic obstructive pulmonary disease surveillance--United States, 1971-2000. , 2002, Morbidity and mortality weekly report. Surveillance summaries.

[12]  J. Brody,et al.  Proportionate mortality trends: 1950 through 1986. , 1990, JAMA.

[13]  M. Engelgau,et al.  The continuing increase of diabetes in the US. , 2001, Diabetes care.

[14]  S. L. Murphy,et al.  Deaths: final data for 2002. , 2004, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[15]  A Gittelsohn,et al.  Annotated bibliography of cause-of-death validation studies. , 1982, Vital and health statistics. Series 2, Data evaluation and methods research.

[16]  Brämer Gr.  International statistical classification of diseases and related health problems. Tenth revision. , 1988, World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales.

[17]  A K Lund,et al.  Changes in motor vehicle occupant fatalities after repeal of the national maximum speed limit. , 1999, Accident; analysis and prevention.