Katie Hastings MPH Stanford Medicine 

Disparities Remain But Blacks Experience Greatest All-Cause Mortality Reductions

MedicalResearch.com Interview with:

Katie Hastings MPH Stanford Medicine 

Kate Hastings

Katie Hastings MPH
Stanford University School of Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart disease has been the leading cause of death since the early 1900s, but recent data has suggested cancer will surpass heart disease in the upcoming decades. To date, this is the first study to examine the transition from heart disease to cancer mortality as the leading cause of death by U.S. county and sociodemographic characteristics using national mortality records from 2003 to 2015.

Our main findings are:

  • Epidemiologic transition is occurring earlier in high compared to low income U.S. counties, and occurs earlier for Asian Americans, Hispanics, and NHWs compared to blacks and American Indians/Alaska Natives.
  • Data may suggest that this shift arises from larger reductions in heart disease than cancer mortality over the study period, particularly in the highest income counties.
  • Continued disparities in heart disease and cancer mortality between blacks and other racial/ethnic groups, even in the highest income quintiles. While blacks continue to have the highest overall mortality than any other group, we do show this population experienced the greatest overall improvements in mortality (i.e. mortality rate reductions over time) for all-cause, heart disease, and cancer compared to all other racial/ethnic groups (except for heart disease in Hispanics). 

 MedicalResearch.com: What should readers take away from your report?

 Response: While we have made significant strides to reduce heart disease mortality overall, certain populations are being left behind in this progress. Particularly, the most vulnerable such as the lowest-income counties. Although we do note improvements in mortality for most groups, our results reiterate the importance of continued efforts to bridge the health gaps between diverse populations. For populations already transitioning to cancer mortality as the leading cause, tailored healthcare and preventive strategies may need to be introduced as a result of these and other recent findings.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We did not account for prior common factors influencing county income and mortality, such as local tax policies and regulations, heath care access, etc. The goal of our study was to provide a description of mortality patterns rather than attempting to estimate a causal relationship, but this is an important next step.  This transition is complex due to the large overlap in risk factors for these chronic diseases, and may be explained by various socioeconomic/demographic, geographic, and political factors that we were unable to uncover in this analysis. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: Other notable findings include an overall increase in all-cause mortality for only American Indians/Alaskan Natives over the study period. Recent reports have also described this finding, and warrants a call to action to address this disparity.

No disclosures.


Hastings KG, Boothroyd DB, Kapphahn K, Hu J, Rehkopf DH, Cullen MR, et al. Socioeconomic Differences in the Epidemiologic Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States, 2003 to 2015An Observational Study. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M17-0796

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Last Updated on November 13, 2018 by Marie Benz MD FAAD