Cancer to surpass heart disease as leading cause of death in the U.S. for higher-income persons

1. The findings of this study suggested that cancer is becoming the leading cause of death in the United States among higher-income counties.

2. The authors observed that lower-income counties were more likely to have heart disease as the leading cause of death.

Evidence Rating Level: 2 (Good)

Study Rundown: The epidemiologic transition theory describes a shift in causes of death from infectious conditions to chronic diseases. This trend has been reflected in developed countries, as well as more recently in some developing countries. Previously, heart disease was considered the highest cause of death among Americans. However, recent data has suggested that the cause of death is shifting from heart disease to cancer in high-income countries. The authors of this study examined county-level sociodemographic differences in causes of death in the United States, assessing the transition from heart disease to cancer. The study was limited through several factors. Of note, it utilized median household income as an indicator of socioeconomic status, which may not be entirely accurate in some cases. Cost of living was also not factored into income calculations. Further there was a possibility that causes of deaths were misclassified on death records. The strengths of this study included the large-scale nature and time frame during which the study was conducted. Overall, the results of the study suggest that among high-income counties in the United States, the cause of death is shifting from heart disease to cancer.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Recent trends in life expectancy across high income countries: retrospective observational study

In-Depth [observational study]: The authors of this observational study examined U.S. death records from 2003 to 2015 to assess cause of death in decedents aged 25 years or older. The outcomes of the study included all-cause, heart disease and cancer mortality; the authors stratified these results by median household income of the county. A total of 32 510 810 deaths from 2003 to 2015 were examined across 3143 U.S. counties. Overall, the study results suggested that in general, there is a transition within the United States in terms of leading cause of death. Specifically, heart disease was the leading cause of death in 79% of counties in 2003, compared to 59% in 2015. In addition to this general trend, they observed that counties with a higher-income were more likely to have cancer as the leading cause of death compared to counties with a lower-income. For example, in higher-income counties the rates of heart disease decreased by 30% from 2003 to 2015 compared to 22% in lower-income counties. Further, heart disease remained the leading cause of death in the lowest-income counties among all racial and ethnic groups. 

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