There is an overall decreasing trend in the age-standardized mortality rate for all causes of death combined, and for five of the six leading causes of death: cardiovascular disease, cancer, stroke, unintentional injuries and diabetes mellitus, according to a study published Oct. 27 in the Journal of the American Medical Association.

The study analyzed U.S. national vital statistics data from 1969 to 2013, and found the age-standardized death rate for all causes combined decreased from 1,279 per 100,000 population to 730 (43 percent reduction) – an average annual decrease of 1.3 percent. The rate of death (per 100,000) decreased for stroke by 77 percent; for cardiovascular disease, by 68 percent; for unintentional injuries, by 40 percent; for cancer, by 18 percent; and for diabetes, by 17 percent. However, the death rate for chronic obstructive pulmonary disease increased by 101 percent. Further, the rate of decrease has slowed for cardiovascular disease, stroke and diabetes. Specifically, the annual decline for cardiovascular disease slowed from 3.9 percent from 2000 to 2010, to 1.4 percent from 2010 to 2013.

The authors note that “the progress against [cardiovascular disease] and stroke is attributed to improvements in control of hypertension and hyperlipidemia, smoking cessation and medical treatment.” However, the recent slowing of the decline in death rates for obesity-related diseases “may reflect the lagged consequences of increased obesity prevalence since the 1980s.”

They conclude that moving forward, “further disease-specific studies are needed to investigate these trends.”

In an accompany editorial comment, J. Michael McGinnis, MD, MPP, of the National Academy of Medicine, writes, “Death rate may have at one time served as a sufficient measure of health system performance, but assessment now requires more textured insights, including those that reflect the improving capacity to measure health status, risk prevalence, and service access, effectiveness and affordability.”

He explains that “What is needed is a set of national vital health indicators that is broader than mortality, but still a limited number, tightly constructed, standardized, and reliably available at all levels from local to national.” He points to the report, Vital Signs: Core Metrics for Health and Health Care Progress, released earlier this year, that recommends 15 core measures across four domains: healthy people, quality care, affordable care and engaged people, “which could be assembled from a manageable set of standardized measures to be collected system-wide,” he adds. 

Keywords: Diabetes Mellitus, Hyperlipidemias, Hypertension, Neoplasms, Obesity, Prevalence, Prevalence, Pulmonary Disease, Chronic Obstructive, Smoking Cessation, Stroke

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