A new JAMA study on mortality has determined that the leading causes of death aren’t killing us quite as handily as they used to.
The analysis, which looked at mortality trends in the U.S. between 1969 and 2013 for the six leading causes of death, found that, overall, death rates for heart disease, cancer, stroke, unintentional injuries and diabetes have dropped 43 percent, from 1,279 deaths per 100,000 people to 730 deaths per 100,000 people. Early deaths, defined as years of potential life lost before age 75, also dropped by 52 percent overall, with the largest declines in stroke and heart disease.
But don’t start celebrating just yet.
The decline in mortality rates for heart disease, stroke and diabetes has actually slowed in recent years. And the death rate for another leading cause of death, COPD or chronic obstructive pulmonary disease, has spiked, particularly for women. Researchers found that the COPD death rate in the last four decades has doubled, increasing from 21 deaths per 100,000 people in 1969 to 42.2 deaths per 100,000 in 2013.
“We’ve concluded that we are making progress in reducing death rates from all causes and most leading causes of death,” said senior author Dr. Ahmedin Jemal, of the American Cancer Society’s (ACS) Surveillance and Health Services Research Program in Atlanta. “However, rates during the most recent time period have slowed for heart disease, stroke and diabetes, likely to due to the obesity epidemic that has unfolded over the last three decades.”
The new report, the first of its kind in 10 years, used national death certificate data to look for trends in how we die in order to help identify ways to modify our lifestyle so we can live longer.
The biggest death rate reduction was in stroke, which showed a 77 percent drop, followed by heart disease, with a 67.5 percent reduction. Cancer deaths dropped 18 percent, from nearly 199 deaths per 100,000 people in 1969 to just over 163 deaths per 100,000 people in 2013. Diabetes death rates also dropped by 16.5 percent.
Dr. Garnet Anderson, director of the Public Health Sciences Division at Fred Hutchinson Cancer Research Center, said it’s rewarding to see that “advances in our understanding of the causes, prevention, early detection and treatment of disease have indeed translated into significantly lower mortality rates for most of the major causes of death. For stroke and heart disease in particular, the reductions in mortality rates are very impressive.”
The ACS researchers attributed the overall drop in heart disease and stroke deaths to improvements in controlling hypertension and hyperlipidemia (increased levels of fats in the blood, including cholesterol and triglycerides) as well as smoking cession and medical treatment. They also pointed to tobacco control efforts, and advances in early detection and treatment, as the main factors in bringing down cancer deaths.
Smoking and obesity still a concern
Dr. Jonathan Bricker, a public health researcher specializing in smoking cession at Fred Hutch, said he was cautiously optimistic about the numbers but stressed that the study, in particular its troubling COPD finding, was a “renewed call” to focus on tobacco cessation programs.
“Tobacco is the first and still the most preventable cause of premature death in the U.S.,” he said. “There are half a million deaths a year attributable to tobacco-related illnesses. To me, that’s what these data speak to. You have to look at the results with caution. There are still areas that need improvement and COPD is an obvious one.”
Bricker characterized COPD — which includes emphysema and chronic bronchitis — as a “terrible” disease that primarily hits smokers. Smoking accounts for as many as 9 out of 10 COPD-related deaths, according to the U.S. Centers for Disease Control and Prevention, but pollutants, second-hand smoke and workplace fumes, chemicals and dust can be contributing factors.
“Basically, the cilia in your lungs become clogged from the tar you’ve taken in from smoking,” he said, explaining how people with the disease slowly lose their ability to breathe. “It’s very difficult for some people to go up a flight of stairs or take a walk and people are getting it ages 35 to 40 years old. Imagine, having to live 20 to 30 years with this illness. It’s debilitating and it’s very sad and the cases of death caused by COPD are on the rise.”
Bricker said that the slowdown in declining deaths for heart disease, stroke and diabetes — characterized as “obesity-related diseases” — also points to a need for more smoking cessation programs.
Tobacco is one of the causes for all those diseases, he said, pointing to the need for more effective interventions capable of reaching the population as a whole. “Again, that’s a modifiable lifestyle factor.”
Jemal, whose research focuses on cancer disparities, said in a recent interview that obesity, smoking, unhealthy diet and physical inactivity account for almost half of the total deaths in the U.S.
“We as health providers can do more to prevent and manage obesity through exercise, diet and therapy for weight loss,” he said, adding that funding, too, was essential, to “invest more in research to discover new prevention, early detection and treatment in order to accelerate the reduction in mortality rates.”
Anderson said the obesity epidemic is a growing concern.
“As the authors indicate, we have yet to see the impact of the obesity epidemic on mortality rates for many of these diseases," she said. "It is worrisome that some of these important gains for heart disease, stroke, cancer and diabetes could be eroded over the next few years by the growing burden of obesity."
She also noted the data offer only a small picture of our health as a nation — and that there’s still much work to be done.
“Comparisons of our longevity and health status to those of other nations, especially when accounting for the cost of health care in the U.S., suggest that there is much yet to be gained."
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Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she also writes the breast cancer blog doublewhammied.com. Reach her at dmapes@fredhutch.org.
