Wednesday, September 14, 2005

COPD Deaths Skyrocket While Heart, Stroke, and Cancer Mortality Decline

COPD Deaths Skyrocket While Heart, Stroke, and Cancer Mortality Decline
Byron Thomashow, MD NY Presbyterian ATLANTA, Sept 13-

The age-adjusted mortality rates attributed to four of the six leading causes of death in the U.S. declined during the past three decades while one stands out by its extraordinary rise -- chronic obstructive pulmonary disease (COPD).
The overall age-standardized death rate fell by 32%. For stroke, it dropped by 63%. The heart disease rate fell by 52% and the accident rate was down by 41%. Cancer squeezed onto the improvement list, although by only 2.7%.
Then there was cigarette-fueled COPD, which rose by 102.8% from 1970 to 2002, according to Ahmedin Jemal, D.V.M., Ph.D., and colleagues of the department of epidemiology and surveillance research at the American Cancer Society here.
In 1970 the COPD age-standardized death rate (per 100,000 per year) was 21.4 deaths, while in 2002 it was 43.4 deaths, according to the death-trend data published in the Sept 14 issue of the Journal of the American Medical Association.
The age-standardized death rate from diabetes, one of the six leading causes of death analyzed, also increased during the study from a rate of 24.6 deaths (per 100,000 per year) in 1970 to 25.4 deaths (per 100,000 per year) in 2002.
The increases in COPD and diabetes age-standardized death rates are grim evidence of the impact of two major public health concerns: tobacco and obesity.
The increase in COPD age-standardized death rates results largely from the long-term effects of tobacco smoking in an aging population, said the investigators. The increase in diabetes deaths, they wrote, "reflects dramatic increases in obesity."
Causes of death vary by age and in 2002 the leading cause of death in persons age 75 or older was heart disease, while cancer was the leading cause of death for people ages 40 to 74, and accidents were the leading cause of deaths in those younger than 40.
The researchers analyzed death certificate data and classified causes of death by ICD-8, ICD-9, and ICD-10 coding.
Between 1970 and 2002 the age-adjusted standardized death rate from all causes combined decreased 32% from 1242.2 to 844.6 based on the year 2000 age standard.
The age-adjusted standardized rate per cause of death is as follows:
1970 heart disease 502.6 (per 100,000 per year) versus 2002 240.6 (per 100,000 per year)
1970 cancer 198.8 (per 100,000 per year) versus 2002 193.5 (per 100,000 per year)
1970 stroke 151.9 (per 100,000 per year) versus 2002 56.1 (per 100,000 per year)
1970 21.4 (per 100,000 per year) versus 2002 43.4 (per 100,000 per year)
1970 accidents 62.5 (per 100,000 per year) versus 2002 36.9 (per 100,00 per year)
1970 diabetes mellitus 24.6 (per 100,000 per year) versus 2002 25.4 (per 100,000 per year).
The decrease in age-standardized death rates in four of the six leading causes of death represents "progress toward one of the fundamental goals of disease prevention by extending the number of years of potentially healthy life," the researchers wrote. That progress, they wrote, has been greater in heart disease than in cancer, but even the cancer death rate has been "decreasing by 1.1% per year since 1993."
The researchers cautioned, however, that the rate of decline in the death rate for stroke and accidents has slowed since the 1990s, suggesting that this decline may be approaching a plateau.
At the same time, the "biphasic trend in cancer mortality rates reflects both the impact of the tobacco epidemic on tobacco-related cancers through 1990, followed by reduction in cancer mortality through tobacco control and advances in early detection, in treatment, or in both," they wrote.
Finally, they pointed out that the flip side of declining death rates is an increase in the number of aging Americans who survive disease but require chronic treatment, which is likely to play out in ever-increasing demands on Medicare.

Primary source: Journal of the American Medical AssociationSource reference: Jemal A et al "Trends in the Leading Causes of Death in the United States, 1970-2002" JAMA 2005;294:1255-1259View this abstract.


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