Abstract MP67: Transition From Cardiovascular Disease to Cancer as the Leading Cause of Death in US States, 1999-2013
Introduction: Cardiovascular disease (CVD) has been the leading cause of death in the US, and cancer the second leading cause of death, consistently since the 1940s. In recent decades, the gap has narrowed due to the steep decline in CVD mortality and relatively modest decline in cancer mortality. We hypothesized that national-level mortality data obscure state-specific transitions from CVD to cancer as the leading cause of death.
Methods: We used state-specific mortality data from the US National Vital Statistics System to calculate state-specific mortality rate ratios (RRs) of CVD vs cancer for each US state annually from 1999 to 2013.
Results: From 1999 to 2013 the national CVD mortality rate fell from 265.9 to 193.3 per 100,000 and the national cancer mortality rate fell from 201.6 to 185.0 per 100,000. Accordingly, the national CVD/cancer mortality RR fell from 1.32 to 1.04. However, from 1999 to 2013 many states transitioned from CVD to cancer as the leading cause of death (see Figure). In 1999 CVD was the leading cause of death in 49 states, with median state-specific CVD/cancer mortality RR of 1.29 (IQR: 1.16, 1.36). New York had the highest mortality RR of 1.57. Only in Alaska was cancer the leading cause of death in 1999, with CVD/cancer mortality RR of 0.89. In contrast, by 2013 CVD remained the leading cause of death in only 27 states, with median state-specific CVD/cancer mortality RR of 1.08 (IQR: 1.04, 1.13). New York still had the highest mortality RR of 1.23. Cancer had become the leading cause of death in 23 states by 2013, with median state-specific CVD/cancer mortality RR of 0.95 (IQR: 0.88, 0.99).
Conclusion: Due to rapidly declining CVD mortality rates, the transition from CVD to cancer as the leading cause of death has already occurred in nearly half of US states. National-level data mask this reality, implying an oversimplified public health message that “CVD is the leading cause of death.” State-specific data highlight successes in CVD prevention and control and the need for further improvements in cancer prevention and control.
Author Disclosures: M.C. Harding: None. C.D. Sloan: None. R.M. Merrill: None. T.M. Harding: None. B.J. Thacker: None. E.L. Thacker: None.
- © 2016 by American Heart Association, Inc.