Temporal Trends in Mortality in the United States, 1969-2013
Temporal Trends in Mortality in the United States, 1969-2013
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DOI：
10.1001/jama.2015.12319
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发表时间：
2015-10-27
影响因子：
120.7
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
--
作者：
Ma, Jiemin;Ward, Elizabeth M.;Jemal, Ahmedin
对死亡率的长期趋势进行系统和全面的评价，对于卫生规划和确定优先事项以及确定可能导致趋势的可改变因素非常重要。目的研究美国所有死因和6种主要死因的死亡时间趋势。设计、环境和参与者：1969年至2013年美国国家生命统计数据的结合点分析。暴露死亡原因主要结局和测量：年龄标准化死亡率和75岁前所有原因和心脏病、癌症、慢性阻塞性肺疾病（COPD）、中风、意外伤害和糖尿病的潜在寿命年数的总变化百分比和年变化百分比。结果1969年至2013年，所有原因的年龄标准化死亡率从1278.8降至729.8（降低42.9%,95% CI, 42.8%-43.0%），卒中从156.8降至36.0（降低77.0%,95% CI, 76.9%-77.2%），心脏病从520.4降至169.1（降低67.5%,95% CI, 67.4%-67.6%），意外伤害从65.1降至39.2（降低39.8%,95% CI, 39.3%-40.3%），癌症从198.6降至163.1(降低17.9%；95% CI, 17.5%-18.2%)，糖尿病患者从25.3降至21.1（降低16.5%;95% CI, 15.4%-17.5%）。相比之下，COPD的发病率从21.0增加到42.2（增加100.6%;95% CI, 98.2%-103.1%）。然而，在联合点分析检测到的最后一段时间内，男性COPD死亡率开始下降，心脏病、中风和糖尿病的死亡率下降速度减慢。例如，心脏病的年降幅从2000-2010年期间的3.9% （95% CI, 3.5%-4.2%）放缓至2010-2013年期间的1.4%(95% CI, -3.4% - 0.6%)（斜率差P = 0.02）。1969年至2013年间，每1000人的年龄标准化潜在寿命损失从糖尿病的1.9年降至1.6年（减少14.5%;95% CI, 12.6%-16.4%），癌症的21.4年降至12.7年（40.6%;95% CI, 40.2%-41.1%），意外伤害的19.9年降至10.4年（47.5%;95% CI, 47.0%-48.0%），心脏病的28.8年降至9.1年（68.3%;95% CI, 68.1%-68.5%），中风的6.0年降至1.5年（74.8%;95% CI, 74.4%-75.3%）。对于慢性阻塞性肺病，潜在寿命损失年数的比率在这段时间内没有下降。根据1969年至2013年的死亡证明数据，所有原因（心脏病、癌症、中风、意外伤害和糖尿病）的年龄标准化死亡率总体呈下降趋势，尽管心脏病、中风和糖尿病的下降速度似乎有所放缓。在此期间，慢性阻塞性肺病的死亡率有所上升。
IMPORTANCE A systematic and comprehensive evaluation of long-term trends in mortality is important for health planning and priority setting and for identifying modifiable factors that may contribute to the trends.OBJECTIVE To examine temporal trends in deaths in the United States for all causes and for the 6 leading causes.DESIGN, SETTING, AND PARTICIPANTS Joinpoint analysis of US national vital statistics data from 1969 through 2013.EXPOSURE Causes of death.MAIN OUTCOMES AND MEASURES Total and annual percent change in age-standardized death rates and years of potential life lost before age 75 years for all causes combined and for heart disease, cancer, chronic obstructive pulmonary disease (COPD), stroke, unintentional injuries, and diabetes mellitus.RESULTS Between 1969 and 2013, the age-standardized death rate per 100 000 decreased from 1278.8 to 729.8 for all causes (42.9% reduction; 95% CI, 42.8%-43.0%), from 156.8 to 36.0 for stroke (77.0% reduction; 95% CI, 76.9%-77.2%), from 520.4 to 169.1 for heart disease (67.5% reduction; 95% CI, 67.4%-67.6%), from 65.1 to 39.2 for unintentional injuries (39.8% reduction; 95% CI, 39.3%-40.3%), from 198.6 to 163.1 for cancer (17.9% reduction; 95% CI, 17.5%-18.2%), and from 25.3 to 21.1 for diabetes (16.5% reduction; 95% CI, 15.4%-17.5%). In contrast, the rate for COPD increased from 21.0 to 42.2 (100.6% increase; 95% CI, 98.2%-103.1%). However, during the last time segment detected by joinpoint analysis, death rate for COPD in men began to decrease and the declines in rates slowed for heart disease, stroke, and diabetes. For example, the annual decline for heart disease slowed from 3.9% (95% CI, 3.5%-4.2%) during the 2000-2010 period to 1.4%(95% CI, -3.4% to 0.6%) during the 2010-2013 period (P = .02 for slope difference). Between 1969 and 2013, age-standardized years of potential life lost per 1000 decreased from 1.9 to 1.6 for diabetes (14.5% reduction; 95% CI, 12.6%-16.4%), from 21.4 to 12.7 for cancer (40.6%; 95% CI, 40.2%-41.1%), from 19.9 to 10.4 for unintentional injuries (47.5%; 95% CI, 47.0%-48.0%), from 28.8 to 9.1 for heart disease (68.3%; 95% CI, 68.1%-68.5%), and from 6.0 to 1.5 for stroke (74.8%; 95% CI, 74.4%-75.3%). For COPD, the rate for years of potential life lost did not decrease over this time interval.CONCLUSIONS AND RELEVANCE According to death certificate data between 1969 and 2013, an overall decreasing trend in age-standardized death rate was observed for all causes combined, heart disease, cancer, stroke, unintentional injuries, and diabetes, although the rate of decrease appears to have slowed for heart disease, stroke, and diabetes. The death rate for COPD increased during this period.