Mortality Trends in the United States, 1969-2013

Study Questions:

Have mortality rates changed over the past several decades for the six leading causes of death?


Mortality rates were examined from 1969 to 2013 using data from the US National Vital Statistics System of the National Center for Health Statistics. Causes of death were examined for total mortality and annual percent change in age-standardized death rates and years of potential life lost prior to the age of 75 years. Disease-specific causes were examined including heart disease, cancer, chronic obstructive pulmonary disease (COPD), stroke, unintentional injuries, and diabetes.


Over the time period examined (1969-2013), the age-standardized death rate per 100,000 decreased for all-cause mortality (42.9% reduction; 95% confidence interval [CI], 42.8%-43.0%). Reductions in stroke (77.0% reduction; 95% CI, 76.9%-77.2%), heart disease (67.5% reduction; 95% CI, 67.4%-67.6%), unintentional injuries (39.8% reduction; 95% CI, 39.3%-40.3%), cancer (17.9% reduction; 95% CI, 17.5%-18.2%), and diabetes (16.5% reduction; 95% CI, 15.4%-17.5%) were observed. For COPD, mortality rates increased from 21.0 to 42.2 (100.6% increase; 95% CI, 98.2%-103.1%). However, in recent years, COPD death rates appear to have decreased for men, whereas declines in rates have slowed for heart disease, stroke, and diabetes. Between 1969 and 2013, age-standardized years of potential life lost per 1,000 decreased from 1.9 to 1.6 for diabetes (14.5% reduction; 95% CI, 12.6%-16.4%), from 21.4 to 12.7 for cancer (40.6%; 95% CI, 40.2%-41.1%), from 19.9 to 10.4 for unintentional injuries (47.5%; 95% CI, 47.0%-48.0%), from 28.8 to 9.1 for heart disease (68.3%; 95% CI, 68.1%-68.5%), and from 6.0 to 1.5 for stroke (74.8%; 95% CI, 74.4%-75.3%). For COPD, the rate for years of potential life lost did not decrease over this time interval.


The authors concluded that according to death certificate data between 1969 and 2013, an overall decreasing trend in age-standardized death rate was observed for all causes combined—heart disease, cancer, stroke, unintentional injuries, and diabetes—although the rate of decrease appears to have slowed for heart disease, stroke, and diabetes. The death rate for COPD increased during this period.


Understanding trends in mortality over time is important to plan for public health interventions to promote prevention when needed.

Clinical Topics: Prevention

Keywords: Cause of Death, Diabetes Mellitus, Heart Diseases, Mortality, Neoplasms, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Stroke

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