Context The decrease in overall death rates in the United States may mask changes
in death rates from specific conditions.
Objective To examine temporal trends in the age-standardized death rates and in
the number of deaths from the 6 leading causes of death in the United States.
Design and Setting Analyses of vital statistics data on mortality in the United States
from 1970 to 2002.
Main Outcome Measure The age-standardized death rate and number of deaths (coded as underlying
cause) from each of the 6 leading causes of death: heart disease, stroke,
cancer, chronic obstructive pulmonary disease, accidents (ie, related to transportation
[motor vehicle, other land vehicles, and water, air, and space] and not related
to transportation [falls, fire, and accidental posioning]), and diabetes mellitus.
Results The age-standardized death rate (per 100 000 per year) from all
causes combined decreased from 1242 in 1970 to 845 in 2002. The largest percentage
decreases were in death rates from stroke (63%), heart disease (52%), and
accidents (41%). The largest absolute decreases in death rates were from heart
disease (262 deaths per 100 000), stroke (96 deaths per 100 000),
and accidents (26 deaths per 100 000).The death rate from all types of
cancer combined increased between 1970 and 1990 and then decreased through
2002, yielding a net decline of 2.7%. In contrast, death rates doubled from
chronic obstructive pulmonary disease over the entire time interval and increased
by 45% for diabetes since 1987. Despite decreases in age-standardized death
rates from 4 of the 6 leading causes of death, the absolute number of deaths
from these conditions continues to increase, although these deaths occur at
Conclusions The absolute number of deaths and age at death continue to increase
in the United States. These temporal trends have major implications for health
care and health care costs in an aging population.