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. 2023 Nov 29;45(4):799-803.
doi: 10.1093/pubmed/fdad089.

Geographic disparities of cardiovascular and cancer mortality in the USA: 1981-2019

V Lebakula  1 , A G Cosby  2
Affiliations

Geographic disparities of cardiovascular and cancer mortality in the USA: 1981-2019

V Lebakula et al. J Public Health (Oxf). .

Abstract

Background: Cardiovascular and cancer mortality are the two leading causes of death in the developed world including the USA. However, mortality trends for these diseases are highly dynamic, and the geographic landscape is in transition. We analyze patterns of mortality improvement at county level during recent decades focusing on mortality decline and geographic diversity.

Methods: We grouped age-adjusted mortality rates of cardiovascular and cancer diseases from CDC WONDER for 2959 US counties into 3-year time periods to improve reliability. We calculated percent mortality decrease between 1981-83 and 2016-19 for both causes to quantify mortality improvements for counties.

Results: Using standard deviation as an index of disparities, place-based cancer mortalities were 68% larger than cardiovascular disparities. Significantly, 566 US counties had same or higher rates of cancer mortality in 2019 as in 1981. The geographic distribution of mortality improvement in either cause tends to favor largely populated areas along coasts. Less-populated, rural places in the interior and southeastern regions were experiencing less improvement.

Conclusions: At the county level, large place-based disparities exist for both causes of death with the magnitude of disparities being substantially larger for the reduction in cancer deaths. Put differently, place matters, more for cancer than cardiovascular mortality.

Keywords: Cancer mortality; Cardiovascular mortality; Geographic mortality disparities; Leading causes of death; Mortality among US counties.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Grouped frequency distribution plot of percent decrease in cardiovascular and cancer mortality of 2959 counties in the USA: 1981–2019. The cancer improvement curve is in red, and the cardiovascular improvement curve is in green. Red and green dotted lines represent the county mean percent decrease in cancer and cardiovascular mortality, respectively. The black dotted line is a zero line and decrease in mortality rates was observed only on the right-hand side of this line.
Fig. 2
Fig. 2
Geographic disparities in age-adjusted mortality improvement in cardiovascular and cancer diseases in the USA: 1981–83 through 2017–19. Footnote: These maps portray county-level disparities in the rate of cardiovascular and cancer mortality for US counties for the period 1981–83 through 2017–19. In each map, county rates of change are compared with national rates of change where national improvement for cardiovascular was 57.33% and national improvement for cancer was 27.43%. (a) The maroon-shaded counties exceeded the national average in both cardiovascular and cancer mortality. (b) Blue shading indicates counties below the national average for cardiovascular and cancer. (c) Green shading indicates counties with cardiovascular improvements exceeding the national average, and in (d) red shading indicates counties with cancer exceeding the national average.
See this image and copyright information in PMC

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References

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