Death rates for heart disease and stroke declined over four decades

The death rates for heart disease, stroke and other conditions significantly declined between 1969 and 2013, according to an analysis of U.S. national vital statistics data.

During that time period, the age-standardized death rate per 100,000 decreased 67.5 percent for heart disease, 77 percent for stroke, 42.9 percent for all causes, 17.9 percent for cancer, 39.8 percent for unintentional injuries and 16.5 percent for diabetes. Meanwhile, the death rate for chronic obstructive pulmonary disease (COPD) increased 100.6 percent.

However, the annual decline for heart disease slowed from 3.9 percent from 2000 to 2010 to 1.4 percent from 2010 to 2013 and the annual decline for stroke slowed from 5.5 percent during 2001 to 2007 to 3 percent from 2007 to 2013.

Lead researcher Jiemin Ma, PhD, MHS, of the American Cancer Society, and colleagues published their results in JAMA on Oct. 27.

“The progress against heart disease and stroke is attributed to improvements in control of hypertension and hyperlipidemia, smoking cessation, and medical treatment,” they wrote. "Our observed recent attenuation in declining death rates for obesity-related diseases (eg, heart disease, stroke, and diabetes) may reflect the lagged consequences of increased obesity prevalence since the 1980s. A similar leveling off of declines in death rates for coronary heart disease among young adults has been observed in Wales and England and Australia. In addition to obesity, explanations for these patterns include ceiling on life expectancy, although the slowdown was also observed in premature deaths (measured by years of potential life lost), and slowing of the rate of discovery and dissemination of public health and clinical interventions that have driven declines in morality in recent decades.”

The age-standardized death rate for all causes decreased an average of 1.3 percent per year, although it decreased only 0.4 percent per year from 2010 to 2013. The researchers noted the death rate decreased continuously for males between 1969 and 2013 and decreased for females until 2009 before leveling off.

During the time period studied, the age-standardized death rate per 100,000 decreased from 156.8 to 36 for stroke, 520.4 to 169.1 for heart disease, 65.1 to 39.2 for unintentional injuries, 198.6 to 163.1 for cancer and 25.3 to 21.1 for diabetes. The death rate for COPD increased from 21 per 100,000 to 42.2 per 100,000.

The researchers noted that males and females experienced similar trends for heart disease, cancer, stroke and diabetes.

“Further disease-specific studies are needed to investigate these trends,” the researchers wrote. “Regardless of the changes in death rates, the increasing numbers of old persons in the United States and growth of the US population will pose a considerable challenge for health care delivery in the coming decades, in view of the shortage of primary care physicians and geriatricians, increasing cost of health care, and the lag between healthy life and life expectancies.”