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"We're just on the cusp of the transition from heart disease to cancer leading causes of death," said Dr. Latha Palaniappan, lead author of the study and internist, professor and clinical researcher at Stanford University Medical Center.
Recent data suggests that the nation is experiencing a new transition, this time within the chronic disease category itself. To understand these changes, Stanford Medical School researchers examined more than 32 million death records across 3,143 American counties for 2003 through 2015. The research team reviewed the results of the study.
Over the 13-year study period, the mortality rate decreased in the total population by 12%, from about 823 deaths per every 100,000 people to roughly 724 deaths per 100,000.
In 2003, the heart disease was the leading cause of death in 2003, yet this remained true for only 59% of counties in 2015.
By contrast, cancer caused the most deaths in each of the 10 counties during 2003, with the same true for every 10 counties in 2015.
While the overall heart disease mortality rate decreased by 28%, high-income counties experienced a 30% drop, versus a 22% fall in low-income counties. The cancer mortality rate also dropped, though dramatically: It declined by 16%, with an 18% drop seen in high income counties versus 11% in low-income.
According to the researchers, lower-income areas can be seen in the cause of death in socioeconomic, geographic, demographic and other factors that influence health and death.
The researchers also compared shifts in patterns for racial and ethnic groups. Here, they found that among Asian-Americans, Hispanics and whites, the cause of death. However, a similar pattern was seen among American Indians / Alaska natives or blacks.
Economic factors also affect the new pattern of mortality rates across the nation. Heart disease surpassed other causes of death in the lowest-income counties for all racial and ethnic groups during 2015, the researchers found, only Asian-Americans, Hispanics and whites in the highest-income counties saw cancer outpatient heart disease as the leading cause of death in 2015.
Making improvements in cancer care available to all
"The driving force behind the transition from the age of 'pestilence and famine' to the age of 'manmade diseases' is in socioeconomic conditions, such as standards of living, health habits, hygiene, and nutrition," Stringhini and Guessous wrote.
How genetic testing, screening and personalized medicine is still unclear, they noted. New and expensive cancer therapies are being introduced, yet they can contribute to "increasing social inequalities in cancer survival, with better-off experiences in more rapid decreases in mortality," they added. And the same may be true of genetic testing and cancer screening, they noted.
It is likely that any differences in mortality trends, between obesity and diabetes trends among high and low income groups, the authors stated. "For example, between 1960 and 2015, the prevalence of smoking in the United States decreased from 39% to 6% among college graduates but from 46% to 23% among those who did not complete high school," they wrote.
With cancer in the heart of the world, what do most Americans need to know?
"Undergoing all of the recommended cancer screenings," Palaniappan advised, and adopting "lifestyle prevention practices, such as healthy diet and exercise, which are beneficial in lowering both cancer and heart disease mortality."
"The investments in both heart disease and cancer are going down," she said. "Without all of the wonderful new therapies we would have, this would not have happened."
Still, there's more work to be done, she said: "We need to work harder in lower income areas of the US so they can see the same improvements in mortality. African-American populations particularly. "
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