Between 1969 and 2013, the death rate for all causes declined 43 percent from about 1,279 people for each 100,000 individuals in the population to about 730 per 100,000, according to the study published today in JAMA, the journal of the American Medical Association.
Five of the six leading causes of death declined during the study period. Death rates dropped 77 percent for stroke, 68 percent for heart disease, 40 percent for unintended injuries, 18 percent for cancer, and 17 percent for diabetes.
“The leading causes of death examined in this study – except unintentional injuries – all are chronic conditions,” said lead study author Jiemin Ma, director of the surveillance and health services research program at the American Cancer Society.
“Tobacco control, high blood pressure prevention and management, early detection and screening, and improvements in treating heart disease, stroke and some types of cancer have substantially contributed to reductions in death rates,” Ma added by email.
Only one of the six leading causes of death – chronic obstructive pulmonary disease – didn’t drop. Rates of death from COPD doubled despite a decline in deaths among men near the end of the study period.
To examine long-term trends in mortality, Ma and colleagues analyzed U.S. national vital statistics to determine the total and annual percent change in age-standardized death rates and years of life lost before age 75 for all causes combined and for the leading causes.
While death rates for five of the six leading causes dropped, the magnitude of the declines recently started to slow for heart disease, stroke and diabetes, the study found.
The progress against heart disease and stroke is due to improvements in controlling high blood pressure and cholesterol, smoking cessation and advances in treatment, the authors conclude.
Reductions in cancer deaths since the early 1990s is also due to tobacco control efforts as well as gains in early detection and treatment, the authors note.
One limitation of the study is its reliance on death certificates to indicate disease-specific trends, the authors acknowledge. This data tends to be more accurate for cancer and injuries, but under-report deaths from COPD, stroke and diabetes and over-report deaths from heart disease.
In addition, the focus on death rates is no longer a sufficient measure of the quality of care delivered in the U.S., said Dr. Michael McGinnis, of the National Academy of Medicine in Washington, D.C., in an editorial.
Earlier this year, a report from the Institute of Medicine recommended that the performance of the healthcare system be measured based on four domains – healthy people, quality care, affordable care, and engaged patients, McGinnis noted.
“Looking only at death rates, and primarily at mortality prominent in 1969, gives a necessary but not sufficient profile of the health of the nation and the citizens within it – missing issues like the rapid ascendance of Alzheimer’s disease, the rise and reduction of HIV/AIDS, the more recent ascendance of diabetes deaths (tracking the obesity epidemic) and persistent disparities in health care, for example the sustained gap between blacks and whites,” McGinnis said by email.
“We now have the science and the capacity to develop a system of vital signs that can give a much better picture of our health progress,” McGinnis added.