- Despite an increased focus on preventative care and chronic disease management, gains in mortality rates are slowing down for most common conditions, and actually increasing for chronic obstructive pulmonary disease (COPD), according to new data published in the Journal of the American Medical Association (JAMA).
Mortality rates steadily declined between 1969 and 2010, say researchers from the American Cancer Society, but leveled off between 2010 and 2013. During the entire time period, the age-standardized health rate for all causes of mortality decreased from 1278.8 per 100,000 people to 729.8, representing a 1.3 percent decrease.
However, in 2010, that rate began to slow. Between 2010 and 2013, there was no notable difference in mortality rates compared to the period between 2002 and 2010, due in part to fewer deaths among females.
Five of the six leading causes of death showed notable decreases during the study period. Stroke deaths went down by 77 percent, heart disease deaths decreased by 67.5 percent, and diabetes deaths were reduced by 16.5 percent, despite an increase in the prevalence of the disease. Unintentional injuries saw a 39.8 percent decline, and cancer deaths went down by 17.9 percent, the study found.
COPD was the only top cause of death that experienced an increase. The death rate from the respiratory disorder increased from 21 per 100,000 people in 1969 to 42.2 in 2013, representing a 100.6 percent increase. Female patients have become increasingly likely to die from COPD since the beginning of the study period, while male deaths decreased by 1.2 percent between 1999 and 2013.
The study authors point to improved chronic disease management programs and widespread wellness efforts, such as the reduction of tobacco use and more robust screening efforts, for the significant gains in longevity.
“Notably, the years-of-potential-life-lost rate (<75 years) from cancer has been decreasing since 1969, preceding the decline in cancer death rates by about 20 years,” the study added. “This may reflect the importance of smoking cessation in substantially reducing premature mortality.”
The study suggests several of the top killers, including COPD and obesity-related diseases like diabetes, may be subject to a “lag” effect. While tobacco use has decreased significantly in recent years, patients who may have smoked regularly during their youth could only just now be developing severe COPD. Patients who may have become obese in the 1980s and 1990s, before the seriousness of the condition gained such widespread attention, may be starting to struggle with diabetes as they age.
The sudden surge of providers investing in population health management and chronic disease management activities may have an impact on future data as the healthcare system turns its attention to improving quality of life and reducing deaths from diabetes, heart disease, and stroke. Predictive analytics and patient risk stratification technologies are helping providers identify the development of chronic diseases earlier and more comprehensively, potentially slowing their progression or forestalling their impacts entirely.
Precision medicine efforts may also boost the cancer survival rate even further, as tailored therapies for previously untreatable conditions enter the realm of clinical possibility.
However, the rapid increase in the number of elderly patients coupled with a looming shortage of healthcare providers may make it difficult for the industry to push forward with longevity gains at a progressive pace, the authors note.
“Further disease-specific studies are needed to investigate these trends,” the study concludes. “Regardless of the changes in death rates, the increasing numbers of old persons in the United States and growth of the US population will pose a considerable challenge for health care delivery in the coming decades, in view of the shortage of primary care physicians and geriatricians, increasing cost of health care, and the lag between healthy life and life expectancies.”