Geographic disparities of cardiovascular and cancer mortality in the USA: 1981-2019.

Abstract

Cardiovascular and cancer mortality are the two leading causes of death in the developed world including the USA. However, mortality trends for these diseases are highly dynamic, and the geographic landscape is in transition. We analyze patterns of mortality improvement at county level during recent decades focusing on mortality decline and geographic diversity. We grouped age-adjusted mortality rates of cardiovascular and cancer diseases from CDC WONDER for 2959US counties into 3-year time periods to improve reliability. We calculated percent mortality decrease between 1981-83 and 2016-19 for both causes to quantify mortality improvements for counties. Using standard deviation as an index of disparities, place-based cancer mortalities were 68% larger than cardiovascular disparities. Significantly, 566US counties had same or higher rates of cancer mortality in 2019 as in 1981. The geographic distribution of mortality improvement in either cause tends to favor largely populated areas along coasts. Less-populated, rural places in the interior and southeastern regions were experiencing less improvement. At the county level, large place-based disparities exist for both causes of death with the magnitude of disparities being substantially larger for the reduction in cancer deaths. Put differently, place matters, more for cancer than cardiovascular mortality.