Heart Disease and Cancer Deaths - Trends and Projections in the United States, 1969-2020

Abstract

Introduction: Heart disease and cancer are the first and second leading causes of death in the United States. Age-standardized death rates (risk) have declined since the 1960s for heart disease and for cancer since the 1990s, whereas the overall number of heart disease deaths declined and cancer deaths increased. We analyzed mortality data to evaluate and project the effect of risk reduction, population growth, and aging on the number of heart disease and cancer deaths to the year 2020.

Methods: We used mortality data, population estimates, and population projections to estimate and predict heart disease and cancer deaths from 1969 through 2020 and to apportion changes in deaths resulting from population risk, growth, and aging.

Results: We predicted that from 1969 through 2020, the number of heart disease deaths would decrease 21.3% among men (-73.9% risk, 17.9% growth, 34.7% aging) and 13.4% among women (-73.3% risk, 17.1% growth, 42.8% aging) while the number of cancer deaths would increase 91.1% among men (-33.5% risk, 45.6% growth, 79.0% aging) and 101.1% among women (-23.8% risk, 48.8% growth, 76.0% aging). We predicted that cancer would become the leading cause of death around 2016, although sex-specific crossover years varied.

Conclusion: Risk of death declined more steeply for heart disease than cancer, offset the increase in heart disease deaths, and partially offset the increase in cancer deaths resulting from demographic changes over the past 4 decades. If current trends continue, cancer will become the leading cause of death by 2020.

Figure 1

Trends in observed (1969–2014) and predicted (2015–2020) heart disease and cancer deaths attributed to the average person’s risk of dying from the disease (ie, population risk, accounting for such factors as changes in diagnostic and treatment practices), population growth, and population aging, by sex. The blue dashed line (baseline) is the number of deaths from heart disease or cancer that occurred in 1969. The dark yellow (1969–2014) and light yellow (2015–2020) line represents the total number of deaths that would have occurred each year if the population size and age structure remained the same as it was in 1969; this line reflects the effect of changes in population risk. The black (1969–2014) and gray (2015–2020) line represents the total number of deaths that would have occurred if the age structure had remained the same as it was in 1969; this line reflects the effect of changes in risk and population growth. The dark orange (1969–2014) and light orange (2015–2020) line represents the expected number of deaths that actually occurred and thus reflects the combined impact of changes in population risk, growth, and aging. A. Heart disease deaths among men. The number of heart disease deaths attributed to risk declined while the number of heart disease deaths resulting from population growth and aging increased. Observed heart disease deaths declined from 1969 through 2014 and are predicted to increase through 2020, primarily because of an aging population. B. Number of cancer deaths among men. The number of cancer deaths attributed to risk increased from 1969 through 2000 and declined from 2000 forward. The number of cancer deaths resulting from population growth and aging increased. Observed cancer deaths increased from 1969 through 2014 and are predicted to continue to increase through 2020, primarily because of an aging population. C. Number of heart disease deaths among women. The number of heart disease deaths attributed to risk declined while the number of heart disease deaths resulting from population growth and aging increased. Observed heart disease deaths increased from 1969 through 1995, primarily because of an aging population. Observed heart disease deaths are predicted to continue to decrease through 2020, primarily because of continued risk reduction. D. Number of cancer deaths among women. The number of cancer deaths attributed to risk increased from 1969 through 2000 and declined from 2000 forward. The number of cancer deaths resulting from population growth and aging increased. Observed cancer deaths increased from 1969 through 2015 and are predicted to continue to increase through 2020, primarily because of an aging population.

Figure 2

Age-standardized death rates (ASDR) and the observed and predicted number of cancer and heart disease deaths from 1969 through 2020 for men and women combined. [Table: see text]