Socioeconomic Differences in the Epidemiologic Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States, 2003 to 2015: An Observational Study.
Level 3 - non-randomized controlled study
Population-based longitudinal registry study using national vital statistics
PubMed 30422275 · doi:10.7326/M17-0796
What was done
Researchers conducted an observational study using U.S. national death records from 2003 to 2015 for decedents aged 25 years or older. They analyzed all-cause, heart disease, and cancer mortality stratified by quintiles of county median household income and racial/ethnic groups, calculating age- and sex-adjusted mortality rates and average annual percentage changes.
What was found
Heart disease was the leading cause of death in 79% of U.S. counties in 2003 and decreased to 59% in 2015, while cancer was the leading cause in 21% of counties in 2003 and increased to 41% in 2015. Overall heart disease mortality fell by 28% (30% in high-income vs. 22% in low-income counties) and cancer mortality fell by 16% (18% in high-income vs. 11% in low-income counties). In the lowest-income counties, heart disease remained the leading cause of death across all racial and ethnic groups, with smaller improvements seen for both diseases.
Why it matters
The transition from heart disease to cancer as the primary cause of death in the United States is uneven, lagging substantially in lower-income counties due to slower declines in cardiovascular mortality.
Limits
The abstract notes the use of county median household income as an ecological proxy for individual socioeconomic status. Total decedent sample size, specific confidence intervals, individual-level behavioral risks, and healthcare access metrics were not reported in the abstract.
Cited by
- supports Cancer has become the leading cause of death in the state of California, surpassing heart disease.