Temporal Trends in Mortality in the United States, 1969-2013.
Level 3 - non-randomized controlled study
Longitudinal population-based vital statistics registry analysis
PubMed 26505597 · doi:10.1001/jama.2015.12319
What was done
The authors performed a joinpoint analysis of US national vital statistics data from 1969 through 2013. They calculated total and annual percent changes in age-standardized death rates (per 100,000) and years of potential life lost before age 75 (per 1,000) for all causes combined and for six leading causes of death: heart disease, cancer, chronic obstructive pulmonary disease (COPD), stroke, unintentional injuries, and diabetes mellitus.
What was found
Between 1969 and 2013, age-standardized death rates per 100,000 decreased from 1278.8 to 729.8 for all causes (-42.9%; 95% CI, 42.8% to 43.0%), 156.8 to 36.0 for stroke (-77.0%; 95% CI, 76.9% to 77.2%), 520.4 to 169.1 for heart disease (-67.5%; 95% CI, 67.4% to 67.6%), 65.1 to 39.2 for unintentional injuries (-39.8%; 95% CI, 39.3% to 40.3%), 198.6 to 163.1 for cancer (-17.9%; 95% CI, 17.5% to 18.2%), and 25.3 to 21.1 for diabetes (-16.5%; 95% CI, 15.4% to 17.5%). In contrast, COPD death rates increased from 21.0 to 42.2 (100.6% increase; 95% CI, 98.2% to 103.1%), though rates in men began to decrease in the final segment. Declines slowed in the most recent period for heart disease, stroke, and diabetes; annual heart disease decline slowed from 3.9% (2000-2010) to 1.4% (2010-2013; P = .02 for slope difference). Age-standardized years of potential life lost per 1,000 decreased for stroke (-74.8%), heart disease (-68.3%), unintentional injuries (-47.5%), cancer (-40.6%), and diabetes (-14.5%), but did not decrease for COPD.
Why it matters
This study documents broad multi-decade declines in US mortality, particularly from cardiovascular disease and stroke, while identifying a doubling of COPD mortality and a notable deceleration in cardiovascular mortality reductions after 2010.
Limits
The study relies on death certificate vital statistics data, which are subject to changes in diagnostic practices and cause-of-death coding over four decades. The abstract does not report the total number of deaths analyzed or subgroup data across race, ethnicity, socioeconomic status, or geography.
Cited by
- context Cardiovascular and cerebrovascular disease, cancer, and neurodegenerative disease together account for approximately 75% of deaths.