0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Temporal Trends in Mortality in the United States, 1969-2013 FREE

Jiemin Ma, PhD, MHS1; Elizabeth M. Ward, PhD2; Rebecca L. Siegel, MPH1; Ahmedin Jemal, DVM, PhD1
[+] Author Affiliations
1Surveillance and Health Services Research Program, Intramural Research Department, American Cancer Society, Atlanta, Georgia
2Intramural Research Department, American Cancer Society, Atlanta, Georgia
JAMA. 2015;314(16):1731-1739. doi:10.1001/jama.2015.12319.
Text Size: A A A
Published online

Importance  A systematic and comprehensive evaluation of long-term trends in mortality is important for health planning and priority setting and for identifying modifiable factors that may contribute to the trends.

Objective  To examine temporal trends in deaths in the United States for all causes and for 6 leading causes.

Design, Setting, and Participants  Joinpoint analysis of US national vital statistics data from 1969 through 2013.

Exposure  Causes of death.

Main Outcomes and Measures  Total and annual percent change in age-standardized death rates and years of potential life lost before age 75 years for all causes combined and for heart disease, cancer, chronic obstructive pulmonary disease (COPD), stroke, unintentional injuries, and diabetes mellitus.

Results  Between 1969 and 2013, the age-standardized death rate per 100 000 decreased from 1278.8 to 729.8 for all causes (42.9% reduction; 95% CI, 42.8%-43.0%), from 156.8 to 36.0 for stroke (77.0% reduction; 95% CI, 76.9%-77.2%), from 520.4 to 169.1 for heart disease (67.5% reduction; 95% CI, 67.4%-67.6%), from 65.1 to 39.2 for unintentional injuries (39.8% reduction; 95% CI, 39.3%-40.3%), from 198.6 to 163.1 for cancer (17.9% reduction; 95% CI, 17.5%-18.2%), and from 25.3 to 21.1 for diabetes (16.5% reduction; 95% CI, 15.4%-17.5%). In contrast, the rate for COPD increased from 21.0 to 42.2 (100.6% increase; 95% CI, 98.2%-103.1%). However, during the last time segment detected by joinpoint analysis, death rate for COPD in men began to decrease and the declines in rates slowed for heart disease, stroke, and diabetes. For example, the annual decline for heart disease slowed from 3.9% (95% CI, 3.5%-4.2%) during the 2000-2010 period to 1.4% (95% CI, −3.4% to 0.6%) during the 2010-2013 period (P = .02 for slope difference). Between 1969 and 2013, age-standardized years of potential life lost per 1000 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.

Conclusions and Relevance  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.

Figures in this Article

A systematic and comprehensive examination of long-term trends in mortality is important for health planning and priority setting and for identifying modifiable factors that may contribute to the trends. A report in 20051 examined temporal trends from 1970 through 2002 for 6 leading causes of death in the United States and found that age-standardized death rates decreased for all causes and for heart disease, stroke, cancer, and injuries individually, whereas an overall increasing trend was observed for chronic obstructive pulmonary disease (COPD) and diabetes. However, the evolution of US mortality trends since 2002 for these causes is unknown. Therefore, we updated the previous analysis with 11 additional data years (1969-2013) using the same analytic approaches to describe contemporary mortality trends for all causes and 6 leading causes of death. In addition, we examined trends in years of potential life lost due to premature deaths, another important measure of disease burden.

Data Sources

All death data were obtained from the US National Vital Statistics System (NVSS) of the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention, with 1969-2011 data abstracted from SEER*Stat software2 (1969 is the earliest data year available) and 2012-2013 data abstracted from public-use multiple cause of death files.3 The NCHS annually compiles information on death certificates from 50 states and the District of Columbia into public-use multiple cause of death files, in which the underlying cause of death is selected according to the coding and selection rules of the International Classification of Disease (ICD) revision in use at the time of death (ICD-8 for 1969-1978, ICD-9 for 1979-1998, and ICD-10 for 1999-2013).4 The World Health Organization defines underlying cause of death as “the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury.”5

Over the years, NCHS has developed several automated programs to improve coding of underlying cause of death on death certificates.6 In this study, heart disease was identified by ICD-8 codes 390-398, 402, 404, and 410-429; ICD-9 codes 390-398, 402, 404, and 410-429; and ICD-10 codes I00-I09, I11, I13, and I20-I51. Cancer was identified by ICD-8 codes 140-207; ICD-9 codes 140-208 and 238.6; and ICD-10 codes C00-C97. Stroke was identified by ICD-8 and ICD-9 codes 430-438 and ICD-10 codes I60-I69. Chronic obstructive pulmonary disease was identified by ICD-8 codes 490-493 and 519.3, ICD-9 codes 490-496, and ICD-10 codes J40-J47. Unintentional injuries (including transport crashes [motor vehicle, other land, water, air and space, and other unspecified] and nontransport mishaps [eg, falls, drowning, unintentional discharge of firearms, exposure to smoke, fire and flames, and unintentional poisoning {eg, drug overdose}]) were identified by ICD-8 and ICD-9 codes 800-949 and ICD-10 codes V01-X59 and Y85-Y86. Diabetes mellitus was identified by ICD-8 and ICD-9 code 250 and ICD-10 code E10-E14. Based on the National Human Subjects Protection Advisory Committee’s recommendations, this study did not require institutional review board approval because it analyzes government-issued public use data without individual identifiable information.

Statistical Analysis

Death rates for all-cause and for the leading causes of death were calculated by age and sex from 1969 through 2013 based on the corresponding population published by the US Census Bureau.7 Age-standardized death rates were then calculated according to the 2000 US standard population by 5-year age groups. To understand the burden of premature death, years of potential life lost before age 75 years, were calculated by cause of death. Years of potential life lost for each decedent was calculated by subtracting the age at death in years from 75. The totals for each demographic group were the sum of years of potential life lost for each decedent in the group. Annual age-standardized years of potential life lost per 1000 was adjusted to the 2000 US standard population by single age. We selected 75 years as the reference age because it approximates US life expectancy and is commonly used for such analyses in the scientific literature.8

Joinpoint regression was performed to examine temporal trends in age-standardized death rates and years of potential life lost using Joinpoint Regression Program version 4.1.1 (Statistical Research and Applications Branch, National Cancer Institute).9 A maximum of 5 joinpoints was allowed, and the Bayesian information criterion method was used for model selection. This analysis compared models by starting with no joinpoints and subsequently testing whether 1 or more joinpoints needed to be entered into the model to best fit the data. The most parsimonious models were selected to report the estimated annual percent change (APC) for each time segment detected and the average annual percent change (AAPC) for the full study period, along with their accompanying 95% confidence intervals. The AAPC is a weighted average of the APCs, with the weights equal to the length of the joinpoint segments. The terms increasing or decreasing were used to describe the trend when the APC or AAPC was statistically significantly different from 0; otherwise, stable or level was used. Year categories presented in various results represent year groupings as determined by joinpoint regression. The most recent time period refers to the last joinpoint segment up to 2013.

In addition, we used the Wald test to determine whether a slope change between 2 adjacent slopes was statistically significant. A slowed, leveled, or accelerated increase or decrease refers to adjacent slopes in the joinpoint regression meeting statistical significance for the difference in slopes. All significance tests were 2-sided. Statistical significance was defined as P < .05.

Between 1969 and 2013, the age-standardized death rate for all causes combined decreased from 1278.8 per 100 000 population to 729.8 (42.9% reduction; 95% CI, 42.8% to 43.0%)—an average annual decrease of 1.3% (95% CI, 1.1% to 1.4%) for the entire period (Table 1 and Figure 1). Joinpoint analysis showed that the rate leveled during the 2010-2013 period (APC, −0.4%; 95% CI, −1.9% to 1.0%) after a continuous decrease between 1969 and 2010. However, the APC during the 2010-2013 period was not significantly different (P = .08) from the APC during the 2002-2010 period (APC, −1.7%; 95% CI, −2.1% to −1.4%). In males, the death rate decreased continuously from 1969 through 2013. In females, the rate decreased until 2009 and then leveled between 2009 and 2013 (APC, −0.6%; 95% CI, −1.5% to 0.3%).

Table Graphic Jump LocationTable 1.  Joinpoint Analysis of Age-Standardized Death Rate (per 100 000 Population) for All Causes Combined, Stratified by Sex in the United States, 1969-2013a
Place holder to copy figure label and caption
Figure 1.
Age-Standardized Death Rate From All Causes in the United States, 1969-2013

Data markers represent observed rates; lines are fitted rates based on joinpoint analysis.

Graphic Jump Location

Five of the 6 leading causes of death (Table 2 and Figure 2) experienced an overall decline in death rates from 1969 through 2013. The rate (per 100 000) decreased from 156.8 to 36.0 for stroke (77.0% reduction; 95% CI, 76.9% to 77.2%), from 520.4 to 169.1 for heart disease (67.5% reduction; 95% CI, 67.4% to 67.6%), from 65.1 to 39.2 for unintentional injuries (39.8% reduction, 95% CI; 39.3 to 40.3%), from 198.6 to 163.1 for cancer (17.9% reduction; 95% CI, 17.5% to 18.2%), and from 25.3 to 21.1 for diabetes (16.5% reduction; 95% CI, 15.4% to17.5%). The death rate for COPD increased during this period, from 21.0 per 100 000 in 1969 to 42.2 per 100 000 in 2013 (100.6% increase; 95% CI, 98.2% to 103.1%).

Table Graphic Jump LocationTable 2.  Joinpoint Analysis of Age-Standardized Death Rate per 100 000 Population by Sex and Cause of Death in the United States, 1969-2013a
Place holder to copy figure label and caption
Figure 2.
Age-Standardized Death Rate by Sex and Cause of Death in the United States, 1969-2013.

COPD indicates chronic obstructive pulmonary disease.

Data markers represent observed rates; lines are fitted rates based on joinpoint analysis. Left panels, The blue in the y-axes represents the death rate range from 0 to 500 per 100 000 persons. Right panels, The orange in the y-axes represents the death rate range from 0 to 50 per 100 000 persons.

Graphic Jump Location

Joinpoint analysis showed that the death rate for heart disease continued to decrease until 2010 and then stabilized during the 2010-2013 period (APC, −1.4%; 95% CI, −3.4% to 0.6%), reflecting a significant change (P = .02) in APC from −3.9% (95% CI, −4.2% to −3.5%) during the 2000-2010 period. Death rates for cancer increased from 1973 through 1990, then decreased after the early 1990s, with rates during the most recent time segment (2001-2013) decreasing by 1.5% per year (95% CI, 1.5% to 1.6%). Death rates for stroke decreased continuously throughout the period. However, the annual decrease slowed from 5.5% (95% CI, 4.6% to 6.3%) during the 2001-2007 period to 3.0% (95% CI, 2.3% to 3.7%) during the 2007-2013 period (test on slope difference, P = .006).

Chronic obstructive pulmonary disease rates increased during the 1969-1999 period and then decreased during the 1999-2013 period (APC,−0.3%; 95% CI, −0.0% to −0.5%). The death rate for unintentional injuries decreased during the 1969-1992 period, leveled during the 1992-2000 period, increased during the 2000-2006 period, and then leveled again during the most recent time segment (APC, −0.5%; 95% CI, −1.3% to 0.4%). Trends in the death rate for diabetes changed continually during the study period (1969-2013). Notably, the rate leveled during 2010-2013 (APC, 0.6%; 95% CI, −1.7% to 2.9%), after decreasing 2.8% (95% CI, 3.4% to 2.2%) per year during 2002-2010 (test on slope difference, P = .006).

Analysis of age-standardized death rates by sex (Table 2 and Figure 2) showed that males and females experienced similar trends for heart disease, cancer, stroke, and diabetes. For COPD, the death rate for men increased during the 1969-1985 period, leveled during the 1985-1999 period, and then decreased by 1.2% (95% CI, 1.0% to 1.5%) per year during the 1999-2013 period; in contrast, the rate for females increased throughout the 1969-2013 period, even though the annual increase during the most recent period (1999-2013) was small (APC, 0.3%; 95% CI, 0.0% to 0.5%).

For unintentional injuries, the death rate for men decreased by 0.9% (95% CI, 0.0% to 1.8%) per year during the most recent period (2006-2013), preceded by an increasing trend during the 2000-2006 period and a stable trend during the 1992-2000 period; in contrast, the rate continuously increased during the 1992-2013 period for women.

Trends in premature deaths, expressed as age-standardized years of potential life lost per 1000, are presented in Table 3, eTable 1, eFigure 1, and eFigure 2 in the Supplement. Between 1969 and 2013, the years-of-potential-life-lost rate for all causes decreased from 134.7 to 64.1 (52.4% reduction; 95% CI, 52.2% to 52.6%)—an annual average decrease of 1.7% (95% CI, 1.5% to 2.0%). Premature deaths decreased for all major causes of death except for COPD, which remained constant. Specifically, the years-of-potential-life-lost rate decreased from 1.9 to 1.6 for diabetes (14.5% reduction; 95% CI, 12.6% to 16.4%), from 21.4 to 12.7 for cancer (40.6% reduction; 95% CI, 40.2% to 41.1%), from 19.9 to 10.4 for unintentional injuries (47.5% reduction; 95% CI, 47.0% to 48.0%), from 28.8 to 9.1 for heart disease (68.3% reduction; 95% CI, 68.1% to 68.5%), and from 6.0 to 1.5 for stroke (74.8% reduction; 95% CI, 74.4% to 75.3%).

Table Graphic Jump LocationTable 3.  Joinpoint Analysis of Age-Standardized Years of Potential Life Lost by Cause of Death in the United States, 1969-2013a

Similar to the findings in death rates, the decrease in years-of-potential-life-lost rate slowed for heart disease and leveled for diabetes after 2010. Specifically, APC changed from −2.7% (95% CI, −2.8% to −2.6%) during the years 1993 through 2010 to −0.6% (95% CI, −2.4% to 1.2%) during the years 2010 through 2013 (test on slope difference, P = .03) for heart disease and for diabetes, changed from −2.0% (95% CI, −2.9% to −1.1%) during the years 2003 through 2010, to 1.8% (95% CI, −0.8% to 4.5%) during the years 2010 through 2013 (test on slope difference, P = .01). For cancer, in contrast to the increase and decrease in death rates, premature deaths decreased continuously over the entire study period.

This temporal analysis of deaths in the United States found an overall decreasing trend in the age-standardized death rate between 1969 and 2013 for all causes combined, and for diabetes, heart disease, cancer, stroke, unintentional injuries, and diabetes. However, the rate of decrease appears to have slowed for heart disease, stroke, and diabetes. In contrast, the rate for COPD doubled over this period, while a decreasing trend was observed in men after 1999.

The decrease in the overall death rate, largely due to long-term declines for heart disease, stroke, and cancer, has been reported in several previous studies in the United States10 and in other developed countries.11 The progress against heart disease and stroke is attributed to improvements in control of hypertension and hyperlipidemia, smoking cessation, and medical treatment.1214 The reduction in cancer deaths since the early 1990s is also an outcome of tobacco control efforts, as well as advances in early detection and treatment.15,16 Notably, the years-of-potential-life-lost rate (<75 years) from cancer has been decreasing since 1969, preceding the decline in cancer death rates by about 20 years. This may reflect the importance of smoking cessation in substantially reducing premature mortality.

The overall decrease in the death rate for unintentional injuries has been largely attributed to continuous declines in motor vehicle–related deaths.17 The decline in death rates for unintentional injuries in men beginning in 2006, after an increase during the years 2000 through 2006, was a result of the combination of the slowing of the increase in death rates from drug poisoning since 200618 and the recent acceleration of decreases in motor vehicle–related deaths.19 The continued increase in death rates for COPD in women largely reflects the lagged effects of smoking prevalence.20

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.21,22 A similar leveling off of declines in death rates for coronary heart disease among young adults has been observed in Wales and England23 and Australia.24 In addition to obesity, explanations for these patterns include ceiling on life expectancy,25 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.

Further disease-specific studies are needed to investigate these trends. 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 physicians26 and geriatricians,27 increasing cost of health care,28 and the lag between healthy life and life expectancies.29

Limitations

This study has some limitations. First, inaccuracy of death certificates may influence the interpretation of our findings on disease-specific trends. Validation studies showed that cause-of-death information on death certificates was generally accurate for cancer30 and injuries,31 whereas deaths from COPD,32 stroke,33 and diabetes34 tend to be underreported and deaths from heart disease tend to be overreported.35 There is no evidence that temporal changes in coding of cardiovascular disease (CVD) on death certificates have affected the assessment of CVD’s secular trends.36,37 However, the improvements in diabetes reporting may partly explain the increasing trends in death rates for diabetes in recent years.34

Second, the coding of the underlying cause of death changed during the study period, from ICD-8 to ICD-9 in 1979 and to ICD-10 in 1999. However, the causes of death examined in this study were affected little by these changes, with the comparability ratios of ICD-9 vs ICD-8 and of ICD-10 vs ICD-9, ranging from 0.99 to 1.06.38,39 Moreover, this would not affect our findings for all-cause mortality, which is immune to changes in disease classification. Third, the slowdown in decreasing death rates during the most recent time segment should be interpreted with caution. A short-term trend (2010-2013 for heart disease and diabetes) is prone to random variations, and its predictive value is subject to uncertainties.

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.

Corresponding Author: Jiemin Ma, PhD, MHS, American Cancer Society, 250 Williams St, Sixth Floor, Atlanta, GA 30303 (Jiemin.ma@cancer.org).

Author Contributions: Dr Ma had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Ma, Jemal.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ma, Jemal.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ma.

Study supervision: Jemal.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Funding/Support: This work was supported by the Intramural Research Department of the American Cancer Society.

Role of the Funder/Sponsor: American Cancer Society had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The opinions expressed are solely the responsibility of the authors and do not necessarily reflect the official views of the American Cancer Society.

Correction: This article corrected a P value on November 3, 2015.

Jemal  A, Ward  E, Hao  Y, Thun  M.  Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005;294(10):1255-1259.
PubMed   |  Link to Article
Surveillance Epidemiology, and End Results Program. SEER*Stat database. http://seer.cancer.gov/mortality. Released July 2014. Accessed April 2015.
Public use data file documentation. National Vital Statistics System, Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nvss/mortality_public_use_data.htm. Updated December 30, 2014. Accessed March 24, 2015.
Datasets and related documentation for mortality data. National Vital Statistics System, Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nvss/mortality_methods.htm. Updated August 27, 2015. Accessed March 24, 2015.
World Health Organization. International Statistical Classification of Disease and Related Health Problems: 10th Revision. Geneva, Switzerland: World Health Organization; 1992.
Murphy  SL, Xu  J, Kochanek  KD.  Deaths: final data for 2010. Natl Vital Stat Rep. 2013;61(4):1-117.
PubMed
US Census populations with bridged race categories. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nvss/bridged_race.htm. Updated June 30, 2015. Accessed March 24, 2015.
Xu  J, Kochanek  KD, Murphy  SL, Arias  E.  Mortality in the United States, 2012. NCHS Data Brief. 2014;(168):1-8.
PubMed
Joinpoint Regression Program [computer program]. Version 4.1.1. Bethesda, MD; Statistical Research and Applications Branch, National Cancer Institute; October 2014
Hoyert  DL.  75 years of mortality in the United States, 1935-2010. NCHS Data Brief. 2012;(88):1-8.
PubMed
Lozano  R, Naghavi  M, Foreman  K,  et al.  Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-2128.
PubMed   |  Link to Article
Ford  ES, Ajani  UA, Croft  JB,  et al.  Explaining the decrease in US deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388-2398.
PubMed   |  Link to Article
Lackland  DT, Roccella  EJ, Deutsch  AF,  et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology.  Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke. 2014;45(1):315-353.
PubMed   |  Link to Article
Young  F, Capewell  S, Ford  ES, Critchley  JA.  Coronary mortality declines in the US between 1980 and 2000 quantifying the contributions from primary and secondary prevention. Am J Prev Med. 2010;39(3):228-234.
PubMed   |  Link to Article
Jemal  A, Thun  MJ, Ries  LA,  et al.  Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst. 2008;100(23):1672-1694.
PubMed   |  Link to Article
Edwards  BK, Noone  AM, Mariotto  AB,  et al.  Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120(9):1290-1314.
PubMed   |  Link to Article
Centers for Disease Control and Prevention (CDC).  Motor-vehicle safety: a 20th century public health achievement. MMWR Morb Mortal Wkly Rep. 1999;48(18):369-374.
PubMed
Chen  LH, Hedegaard  H, Warner  M.  Drug-poisoning deaths involving opioid analgesics: United States, 1999-2011. NCHS Data Brief. 2014;(166):1-8.
PubMed
Rockett  IR, Regier  MD, Kapusta  ND,  et al.  Leading causes of unintentional and intentional injury mortality: United States, 2000-2009. Am J Public Health. 2012;102(11):e84-e92.
PubMed   |  Link to Article
Thun  MJ, Carter  BD, Feskanich  D,  et al.  50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013;368(4):351-364.
PubMed   |  Link to Article
Flegal  KM, Carroll  MD, Kit  BK, Ogden  CL.  Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491-497.
PubMed   |  Link to Article
Flegal  KM, Carroll  MD, Kuczmarski  RJ, Johnson  CL.  Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998;22(1):39-47.
PubMed   |  Link to Article
O’Flaherty  M, Ford  E, Allender  S, Scarborough  P, Capewell  S.  Coronary heart disease trends in England and Wales from 1984 to 2004: concealed levelling of mortality rates among young adults. Heart. 2008;94(2):178-181.
PubMed   |  Link to Article
O’Flaherty  M, Allender  S, Taylor  R, Stevenson  C, Peeters  A, Capewell  S.  The decline in coronary heart disease mortality is slowing in young adults (Australia 1976-2006): a time trend analysis. Int J Cardiol. 2012;158(2):193-198.
PubMed   |  Link to Article
Fries  JF.  Aging, natural death, and the compression of morbidity. N Engl J Med. 1980;303(3):130-135.
PubMed   |  Link to Article
Petterson  SM, Liaw  WR, Phillips  RL  Jr, Rabin  DL, Meyers  DS, Bazemore  AW.  Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503-509.
PubMed   |  Link to Article
Besdine  R, Boult  C, Brangman  S,  et al; American Geriatrics Society Task Force on the Future of Geriatric Medicine.  Caring for older Americans: the future of geriatric medicine. J Am Geriatr Soc. 2005;53(6)(suppl):S245-S256.
PubMed
National Center for Health Statistics. Health, United States, 2013: With Special Feature on Prescription Drugs. Hyattsville, MD: US Dept of Health and Human Services; 2014. DHHS publication 2014-1232.
Murray  CJ, Atkinson  C, Bhalla  K,  et al; US Burden of Disease Collaborators.  The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591-608.
PubMed   |  Link to Article
German  RR, Fink  AK, Heron  M,  et al; Accuracy of Cancer Mortality Study Group.  The accuracy of cancer mortality statistics based on death certificates in the United States. Cancer Epidemiol. 2011;35(2):126-131.
PubMed   |  Link to Article
Moyer  LA, Boyle  CA, Pollock  DA.  Validity of death certificates for injury-related causes of death. Am J Epidemiol. 1989;130(5):1024-1032.
PubMed
Drummond  MB, Wise  RA, John  M, Zvarich  MT, McGarvey  LP.  Accuracy of death certificates in COPD: analysis from the TORCH trial. COPD. 2010;7(3):179-185.
PubMed   |  Link to Article
Halanych  JH, Shuaib  F, Parmar  G,  et al.  Agreement on cause of death between proxies, death certificates, and clinician adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Epidemiol. 2011;173(11):1319-1326.
PubMed   |  Link to Article
McEwen  LN, Karter  AJ, Curb  JD, Marrero  DG, Crosson  JC, Herman  WH.  Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD). Diabetes Care. 2011;34(7):1529-1533.
PubMed   |  Link to Article
Lloyd-Jones  DM, Martin  DO, Larson  MG, Levy  D.  Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med. 1998;129(12):1020-1026.
PubMed   |  Link to Article
Burke  JF, Lisabeth  LD, Brown  DL, Reeves  MJ, Morgenstern  LB.  Determining stroke’s rank as a cause of death using multicause mortality data. Stroke. 2012;43(8):2207-2211.
PubMed   |  Link to Article
Lenfant  C, Friedman  L, Thom  T.  Fifty years of death certificates: the Framingham Heart Study. Ann Intern Med. 1998;129(12):1066-1067.
PubMed   |  Link to Article
Anderson  RN, Miniño  AM, Hoyert  DL, Rosenberg  HM.  Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. Natl Vital Stat Rep. 2001;49(2):1-32.
PubMed
Klebba  AJ, Scott  JH. Estimates of Selected Comparability Ratios Based on Dual Coding of 1976 Death Certificates by the Eighth and Ninth Revisions of the International Classification of Diseases. Hyattsville, MD: National Center for Health Statistics; 1980.

Figures

Place holder to copy figure label and caption
Figure 1.
Age-Standardized Death Rate From All Causes in the United States, 1969-2013

Data markers represent observed rates; lines are fitted rates based on joinpoint analysis.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Age-Standardized Death Rate by Sex and Cause of Death in the United States, 1969-2013.

COPD indicates chronic obstructive pulmonary disease.

Data markers represent observed rates; lines are fitted rates based on joinpoint analysis. Left panels, The blue in the y-axes represents the death rate range from 0 to 500 per 100 000 persons. Right panels, The orange in the y-axes represents the death rate range from 0 to 50 per 100 000 persons.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1.  Joinpoint Analysis of Age-Standardized Death Rate (per 100 000 Population) for All Causes Combined, Stratified by Sex in the United States, 1969-2013a
Table Graphic Jump LocationTable 2.  Joinpoint Analysis of Age-Standardized Death Rate per 100 000 Population by Sex and Cause of Death in the United States, 1969-2013a
Table Graphic Jump LocationTable 3.  Joinpoint Analysis of Age-Standardized Years of Potential Life Lost by Cause of Death in the United States, 1969-2013a

References

Jemal  A, Ward  E, Hao  Y, Thun  M.  Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005;294(10):1255-1259.
PubMed   |  Link to Article
Surveillance Epidemiology, and End Results Program. SEER*Stat database. http://seer.cancer.gov/mortality. Released July 2014. Accessed April 2015.
Public use data file documentation. National Vital Statistics System, Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nvss/mortality_public_use_data.htm. Updated December 30, 2014. Accessed March 24, 2015.
Datasets and related documentation for mortality data. National Vital Statistics System, Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nvss/mortality_methods.htm. Updated August 27, 2015. Accessed March 24, 2015.
World Health Organization. International Statistical Classification of Disease and Related Health Problems: 10th Revision. Geneva, Switzerland: World Health Organization; 1992.
Murphy  SL, Xu  J, Kochanek  KD.  Deaths: final data for 2010. Natl Vital Stat Rep. 2013;61(4):1-117.
PubMed
US Census populations with bridged race categories. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/nvss/bridged_race.htm. Updated June 30, 2015. Accessed March 24, 2015.
Xu  J, Kochanek  KD, Murphy  SL, Arias  E.  Mortality in the United States, 2012. NCHS Data Brief. 2014;(168):1-8.
PubMed
Joinpoint Regression Program [computer program]. Version 4.1.1. Bethesda, MD; Statistical Research and Applications Branch, National Cancer Institute; October 2014
Hoyert  DL.  75 years of mortality in the United States, 1935-2010. NCHS Data Brief. 2012;(88):1-8.
PubMed
Lozano  R, Naghavi  M, Foreman  K,  et al.  Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-2128.
PubMed   |  Link to Article
Ford  ES, Ajani  UA, Croft  JB,  et al.  Explaining the decrease in US deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388-2398.
PubMed   |  Link to Article
Lackland  DT, Roccella  EJ, Deutsch  AF,  et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology.  Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke. 2014;45(1):315-353.
PubMed   |  Link to Article
Young  F, Capewell  S, Ford  ES, Critchley  JA.  Coronary mortality declines in the US between 1980 and 2000 quantifying the contributions from primary and secondary prevention. Am J Prev Med. 2010;39(3):228-234.
PubMed   |  Link to Article
Jemal  A, Thun  MJ, Ries  LA,  et al.  Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst. 2008;100(23):1672-1694.
PubMed   |  Link to Article
Edwards  BK, Noone  AM, Mariotto  AB,  et al.  Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120(9):1290-1314.
PubMed   |  Link to Article
Centers for Disease Control and Prevention (CDC).  Motor-vehicle safety: a 20th century public health achievement. MMWR Morb Mortal Wkly Rep. 1999;48(18):369-374.
PubMed
Chen  LH, Hedegaard  H, Warner  M.  Drug-poisoning deaths involving opioid analgesics: United States, 1999-2011. NCHS Data Brief. 2014;(166):1-8.
PubMed
Rockett  IR, Regier  MD, Kapusta  ND,  et al.  Leading causes of unintentional and intentional injury mortality: United States, 2000-2009. Am J Public Health. 2012;102(11):e84-e92.
PubMed   |  Link to Article
Thun  MJ, Carter  BD, Feskanich  D,  et al.  50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013;368(4):351-364.
PubMed   |  Link to Article
Flegal  KM, Carroll  MD, Kit  BK, Ogden  CL.  Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491-497.
PubMed   |  Link to Article
Flegal  KM, Carroll  MD, Kuczmarski  RJ, Johnson  CL.  Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998;22(1):39-47.
PubMed   |  Link to Article
O’Flaherty  M, Ford  E, Allender  S, Scarborough  P, Capewell  S.  Coronary heart disease trends in England and Wales from 1984 to 2004: concealed levelling of mortality rates among young adults. Heart. 2008;94(2):178-181.
PubMed   |  Link to Article
O’Flaherty  M, Allender  S, Taylor  R, Stevenson  C, Peeters  A, Capewell  S.  The decline in coronary heart disease mortality is slowing in young adults (Australia 1976-2006): a time trend analysis. Int J Cardiol. 2012;158(2):193-198.
PubMed   |  Link to Article
Fries  JF.  Aging, natural death, and the compression of morbidity. N Engl J Med. 1980;303(3):130-135.
PubMed   |  Link to Article
Petterson  SM, Liaw  WR, Phillips  RL  Jr, Rabin  DL, Meyers  DS, Bazemore  AW.  Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503-509.
PubMed   |  Link to Article
Besdine  R, Boult  C, Brangman  S,  et al; American Geriatrics Society Task Force on the Future of Geriatric Medicine.  Caring for older Americans: the future of geriatric medicine. J Am Geriatr Soc. 2005;53(6)(suppl):S245-S256.
PubMed
National Center for Health Statistics. Health, United States, 2013: With Special Feature on Prescription Drugs. Hyattsville, MD: US Dept of Health and Human Services; 2014. DHHS publication 2014-1232.
Murray  CJ, Atkinson  C, Bhalla  K,  et al; US Burden of Disease Collaborators.  The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591-608.
PubMed   |  Link to Article
German  RR, Fink  AK, Heron  M,  et al; Accuracy of Cancer Mortality Study Group.  The accuracy of cancer mortality statistics based on death certificates in the United States. Cancer Epidemiol. 2011;35(2):126-131.
PubMed   |  Link to Article
Moyer  LA, Boyle  CA, Pollock  DA.  Validity of death certificates for injury-related causes of death. Am J Epidemiol. 1989;130(5):1024-1032.
PubMed
Drummond  MB, Wise  RA, John  M, Zvarich  MT, McGarvey  LP.  Accuracy of death certificates in COPD: analysis from the TORCH trial. COPD. 2010;7(3):179-185.
PubMed   |  Link to Article
Halanych  JH, Shuaib  F, Parmar  G,  et al.  Agreement on cause of death between proxies, death certificates, and clinician adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Epidemiol. 2011;173(11):1319-1326.
PubMed   |  Link to Article
McEwen  LN, Karter  AJ, Curb  JD, Marrero  DG, Crosson  JC, Herman  WH.  Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD). Diabetes Care. 2011;34(7):1529-1533.
PubMed   |  Link to Article
Lloyd-Jones  DM, Martin  DO, Larson  MG, Levy  D.  Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med. 1998;129(12):1020-1026.
PubMed   |  Link to Article
Burke  JF, Lisabeth  LD, Brown  DL, Reeves  MJ, Morgenstern  LB.  Determining stroke’s rank as a cause of death using multicause mortality data. Stroke. 2012;43(8):2207-2211.
PubMed   |  Link to Article
Lenfant  C, Friedman  L, Thom  T.  Fifty years of death certificates: the Framingham Heart Study. Ann Intern Med. 1998;129(12):1066-1067.
PubMed   |  Link to Article
Anderson  RN, Miniño  AM, Hoyert  DL, Rosenberg  HM.  Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. Natl Vital Stat Rep. 2001;49(2):1-32.
PubMed
Klebba  AJ, Scott  JH. Estimates of Selected Comparability Ratios Based on Dual Coding of 1976 Death Certificates by the Eighth and Ninth Revisions of the International Classification of Diseases. Hyattsville, MD: National Center for Health Statistics; 1980.
CME


You need to register in order to view this quiz.

Multimedia

Supplement.

eTable 1. Joinpoint Analysis of Age-standardized YPLL (per 1000 population) by Sex and Cause of Death in the US, 1969–2013

eFigure 1. Age-standardized Years of Potential Life Lost (YPLL) from All Causes by Sex in the US, 1969–2013

eFigure 2. Age-standardized YPLL by Sex and Cause of Death in the US, 1969–2013

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

21,070 Views
11 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Multimedia

Author Video Interviews

JAMA Report Video

Author Interview

audio player

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Diabetes, Foot Ulcer

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Diabetic Peripheral Neuropathy