4.  Disease Statistics

• Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1986 and 2006
• Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2006
• Death Rates for Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1987, and 2007
• Deaths Under Age 1 Year Due to Cardiovascular and Lung Diseases, U.S., 2006
• Prevalence of Common Cardiovascular and Lung Diseases, U.S., 2007
• Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2010

Cardiovascular, lung, and blood diseases constitute a large morbidity, mortality, and economic burden on individuals, families, and the Nation. Common forms are atherosclerosis, hypertension, COPD, and blood-clotting disorders—embolisms and thromboses. The most serious atherosclerotic diseases are CHD, as manifested by heart attack and angina pectoris, and cerebrovascular disease, as manifested by stroke.

In 2006, cardiovascular, lung, and blood diseases accounted for 1,053,000 deaths and 43 percent of all deaths in the United States (p. 33). The projected economic cost in 2010 for these diseases is expected to be $705 billion, 23 percent of the total economic costs of illness, injuries, and death (p. 49). Of all diseases, heart disease is the leading cause of death, cerebrovascular disease is third (behind cancer), and COPD (including asthma) ranks fourth (p. 36). Cardiovascular and lung diseases account for 3 of the 4 leading causes of death (p. 36) and 4 of the 10 leading causes of infant death (p. 42). Hypertension, heart disease, asthma, and COPD are especially prevalent and account for substantial morbidity in Americans (p. 45).

The purpose of the biomedical research conducted by the NHLBI is to contribute to the prevention and treatment of cardiovascular, lung, and blood diseases and sleep disorders. National disease statistics show that by midcentury, morbidity and mortality from these diseases had reached record high levels. Since then, however, substantial improvements have been achieved, especially over the past 40 years, as shown by the significant decline in mortality rates. Because many of these diseases begin early in life, their early detection and control can reduce the risk of disability and can delay death. Although important advances have been made in the treatment and control of cardiovascular, lung, and blood diseases, these diseases continue to be a major burden on the Nation.

Mortality statistics in this chapter are for diseases or conditions classified as the underlying cause of death. Heart failure, however, is never truly an underlying cause even though 60,337 deaths in 2006 were nominally coded to it as the underlying cause. Therefore, in this chapter, mortality statistics attributed to any mention of heart failure represent it as either the underlying cause or a contributing cause of death.

The 2006 mortality statistics in this Fact Book are final counts. They differ from the 2006 mortality statistics presented in the FY 2008 Fact Book because those statistics were preliminary.

Cardiovascular Diseases

• In 2006, CVD caused 831,000 deaths—34 percent of all deaths (p. 33).
• Heart disease is the leading cause of death; the main form, CHD, caused 425,000 deaths in 2006 (pp. 34, 36).
• The annual number of deaths from CVD increased substantially from 1900 to 1970 and remains high (p. 35).
• The death rate (not age-adjusted) for CVD increased from 1920 until it peaked in 1968. Since then, the trend has been downward. In 2007, the rate was near the all-time low in 1900 (p. 35).
• Cerebrovascular disease, the third leading cause of death, accounted for 137,000 deaths in 2006 (pp. 34, 36).
• Heart disease is second only to all cancers combined in years of potential life lost (p. 36).
• Heart disease is the leading cause of death in blacks, Hispanics, and American Indians, but second to cancer in Asians. Stroke ranks as the third or fourth leading cause of death in the minority groups, except in American Indians, where it ranks sixth (p. 36).
• From 1979 to 1993 deaths with heart failure as the underlying or contributing cause increased 23 percent and subsequently remained constant to 2006. The increase was a major exception to the mortality decline in CVD over the 26-year period (p. 37).
• From 1999 to 2006, death rates for CHD and stroke declined in men and women of all racial/ethnic groups. CHD mortality remained highest in the black population and lowest in the Asian population. Stroke mortality continues to be highest in the black population (p. 38).
• Because of the rapid decline in mortality from CHD since the peak in 1968, there were 1,086,000 fewer deaths from CHD in 2006 than would have occurred if there had been no decline (p. 39).
• Substantial improvements have been made in the treatment of CVD. Since 1975 or 1985, case-fatality rates from hospitalized AMI, stroke, heart failure, and cardiac dysrhythmia declined appreciably (p. 39).
• The decline in CHD mortality began earlier in the United States than in most countries and outpaced that in most countries until the 1990s (only selected countries are shown) (p. 40).
• From 1999 to 2007, the percentage decline in death rates for CHD and stroke was slightly greater for whites than for blacks (p. 41).
• In 2006, an estimated 81.1 million persons in the United States had some form of CVD, 74.5 million had hypertension, and 17.6 million had CHD (p. 45).
• Since the 1960s, there has been a substantial reduc­tion in the prevalence of CVD risk factors: hyper­tension, smoking, and high cholesterol, but not overweight. The large decline in prevalence of hypertension from 1976–1980 to 1988–1994 was fol­lowed by a slightly higher prevalence in 2001–2004 and 2005–2006 (p. 46).
• From 1976–1980 to 2003–2006, the percentage of persons with hypertension who were aware of their condition, on treatment for it, and having their blood pressure under control increased substantially (p. 47).
• A 2003–2006 national survey showed only about 45 percent of hypertensive patients (systolic BP ≥140 mmHg or diastolic BP ≥ 90 mmHg or on antihypertensive medication) had their condition under control (p. 47).
• Hospitalization rates for heart failure in those aged 45 to 64 years increased from 1971 to 1993 and remained stable to 2006. Rates for those aged 65 years and older increased from 1971 to 1998 and remained relatively stable to 2006.
• The estimated economic cost of CVD for 2010 is approximately $503 billion:
  • $324 billion in direct health expenditures
  • $42 billion in indirect cost of morbidity
  • $137 billion in indirect cost of mortality (p. 49).

Lung Diseases

• Lung diseases, excluding lung cancer, caused an estimated 225,000 deaths in 2006 (p. 33).
• COPD caused 121,000 deaths in 2006 and is the fourth leading cause of death (pp. 34, 36).
• From 1999 to 2007, death rates for COPD and asthma decreased in both black and white men and women, with one exception: the COPD death rate increased slightly in white women (p. 41).
• From 1980 to 2007, infant death rates for various lung diseases declined markedly (p. 41).
• Of the 10 leading causes of infant mortality, 4 are lung diseases or have a lung disease component (p. 42). From 1997 to 2007, changes in mortality for the causes were:
  • Congenital anomalies (-10 percent)
  • Disorders of short gestation (-3 percent)
  • Sudden infant death syndrome (-40 percent)
  • Respiratory distress syndrome (-45 percent).
• About one in five deaths in children under 1 year of age is due to a lung disease (p. 42).
• From 1980 to 2007, the COPD death rate for women in the United States increased significantly compared with the rates in several other countries (p. 43).
• From 1999 to 2006, death rates for COPD decreased slightly for Asian and Hispanic women but were stable for non-Hispanic white and non-Hispanic black women. For men, the rates decreased in all racial/ethnic groups (p. 44).
• Among the sleep disorders, sleep apnea is increasingly being recognized as an important health problem, which can lead to serious consequences. From 1990 to 2006, physician office visits for sleep apnea increased from 108,000 to 3.1 million (p. 44).
• Asthma is a common chronic condition, particularly in children (pp. 45, 46, 48).
• The economic cost of lung diseases is expected to be $186 billion in 2010—$117 billion in direct health expenditures and $69 billion in indirect cost of morbidity and mortality (p. 49).

Blood Diseases

• An estimated 200,000 deaths, 8 percent of all deaths, were attributed to blood diseases in 2006 (p. 33). These include the following:
  • 191,000 due to blood-clotting disorders
  • 9,000 to diseases of the red blood cell and bleeding disorders (p. 34).
• A large proportion of deaths from AMI and cerebrovascular disease involve blood-clotting problems (p. 34).
• In 2010, blood-clotting disorders are expected to cost the Nation’s economy $117 billion, and other blood diseases will cost $16 billion (p. 49).

Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1986 and 2006

* Includes 295,000 CVD deaths involving blood-clotting diseases.
**  Includes 191,000 CVD deaths involving blood-clotting diseases.
†  Includes 13,000 CVD deaths due to pulmonary heart disease.
‡  Includes 12,000 CVD deaths due to pulmonary heart disease.
Source:  Vital Statistics of the United States, National Center for Health Statistics (NCHS).

Deaths by Major Causes, U.S., 2006	Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 2006
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*Excludes 12,000 deaths from pulmonary heart disease (0.6%). **Excludes 191,000 deaths from blood-clotting disorders (8.8%).	*  CVD involving blood clotting (23.0%).

Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2006

*  Deaths from clotting or pulmonary disorders also are included as cardiovascular deaths.
**  This term is preferred to the equivalent term "chronic lower respiratory diseases" given in the 10th revision of the International Classification of Diseases (ICD).
Note:  Total, excluding overlap, is 1,054,000.
Source:  Vital Statistics of the United States, NCHS.

Deaths From Cardiovascular Diseases, U.S., 2006

Deaths From Cardiovascular Diseases, U.S., 2006	Deaths From Lung Diseases, U.S., 2006	Deaths From Blood Diseases, U.S., 2006
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*Includes cardiac dysrhythmias, hypertensive disease, and other heart and blood vessel diseases.

Note:  Numbers may not sum to 100 percent due to rounding.
Source: Estimated by the NHLBI from Vital Statistics of the United States, NCHS.

Deaths From Cardiovascular Diseases, U.S., 1900–2007*

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*Data for 2007 are preliminary.
Source: Vital Statistics of the United States, NCHS.

Death Rates* for Cardiovascular Diseases, U.S., 1900–2007**

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*Not age-adjusted.
**Data for 2007 are preliminary.
Source: Vital Statistics of the United States, NCHS.

Ten Leading Causes of Death: Death Rates, U.S., 2007*

Text-only with data points Years of potential life lost (millions)‡ 3.4 4.9 0.6 0.6 3.2 <0.1 0.6 0.2 0.2 0.3

*Data for 2007 are preliminary.
* *Includes 133.9 deaths per 100,000 population from CHD.
† COPD and allied conditions (including asthma); the term in the ICD/10 is "chronic lower respiratory diseases."
‡ Based on the average remaining years of life up to age 77 years.
Note: Diseases shown in bold are those addressed in Institute programs.
Source: Vital Statistics of the United States, NCHS.

Ten Leading Causes of Death Among Minority Groups, U.S., 2006

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* Includes deaths among individuals of Asian extraction and Asian-Pacific Islanders.
** Includes deaths among Aleuts and Eskimos.
Note: Causes of death shown in bold are those addressed in Institute programs.
Source: Vital Statistics of the United States, NCHS.

Age Adjusted Death Rates for Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1987, and 2007*

* Data for 2007 are preliminary.
**  Comparability ratio (1.0502) applied.
† Comparability ratio (1.0411) applied.
Source:  Vital Statistics of the United States, NCHS.

Deaths Attributed to Heart Failure,* U.S., 1970–2006

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^* Any mention of heart failure on the death certificate.
Note:  Breaks in trend line indicate change in ICD codes.
Source: Vital Statistics of the United States, NCHS.

Age-Adjusted Death Rates for Heart Disease by Race/Ethnicity and Sex, U.S., 1999–2006

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*Non-Hispanic. Source: Vital Statistics of the United States, NCHS.

Age-Adjusted Death Rates for Stroke by Race/Ethnicity and Sex, U.S., 1999–2006

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*Non-Hispanic. Source: Vital Statistics of the United States, NCHS.

Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1950–2006^*
Actual Rate and Expected Rates if Rise Had Continued or Reached a Plateau

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Source: Vital Statistics of the United States, NCHS.

Common Cardiovascular and Lung Diseases With High Percentage Discharged Dead From Hospitals, U.S., 1975, 1985, and 2006

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Source: National Hospital Discharge Survey, NCHS.

Death Rates* for Coronary Heart Disease in Men, Ages 35–74, in Selected Countries, 1970–2007

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* Age-adjusted to the European Standard Population.
** 2007 data for the United States are preliminary.
Source:  World Heath Statistics Annual, World Health Organization (WHO).

Death Rates* for Coronary Heart Disease in Women, Ages 35–74, in Selected Countries, 1970–2007

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* Age-adjusted to the European Standard Population.
** 2007 data for the United States are preliminary.
Source:  World Heath Statistics Annual, WHO.

Percent Change in Age-Adjusted Death Rates for Selected Causes by Race and Sex, U.S., 1999–2007*

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^*  Data for 2007 are preliminary.
Source:  Vital Statistics of the United States, NCHS.

Death Rates for Lung Diseases in Infants, U.S., 1980–2007*

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^*  Data for 2007 are preliminary.
Source:  Vital Statistics of the United States, NCHS.

Ten Leading Causes of Infant Mortality, U.S., 2007

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^*   Data for 2007 are preliminary.
^** Congenital CVD and congenital respiratory diseases accounted for 46.2 deaths under age 1 per 100,000 live births (black bar), which is 35 percent of infant deaths due to all congenital anomalies.
^†  From 1997 to 2007, congenital CVD declined 29 percent; congenital anomalies of the respiratory system declined 46 percent; other congenital anomalies increased 11 percent.
NA:  Not available.
Note:  Diseases shown in bold are those addressed in Institute programs.
Source:  Vital Statistics of the United States, NCHS.

Deaths Under Age 1 Year Due to Cardiovascular and Lung Diseases, U.S., 2006

Cause of Death	Deaths Under Age 1	Text-only with data points
All Causes	28,527
Cardiovascular Diseases	2,175
Congenital Anomalies	1,632
Other	543
Lung Diseases	5,077
Sudden Infant Death Syndrome	2,323
Respiratory Distress Syndrome	825
Pneumonia	245
Bronchopulmonary Dysplasia (BPD)	225
Atelectasis of Newborn	398
Congenital Anomalies	437
Other Lung Diseases	624
Other Diseases	21,275

Note:  Diseases shown in bold are those addressed in Institute programs.
Source:  Vital Statistics of the United States, NCHS.

Death Rates* for Chronic Obstructive Pulmonary Disease, including Asthma, in Men, Ages 35 and Older, in Selected Countries, 1980–2007

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* Age-adjusted to the European Standard Population.
** 2007 data for the United States are preliminary.
Source: World Health Statistics Annual, WHO.

Death Rates^* for Chronic Obstructive Pulmonary Disease, including Asthma, in Women, Ages 35 and Older, in Selected Countries, 1980–2007

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* Age-adjusted to the European Standard Population.
** 2007 data for the United States are preliminary.
Source: World Health Statistics Annual, WHO.

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease* by Race/Ethnicity and Sex, U.S., 1999–2006

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^*COPD and allied conditions (including asthma); the term in the ICD/10 is "chronic lower respiratory diseases."
^** Non-Hispanic.
Source:  Vital Statistics of the United States, NCHS.

Physician Office Visits for Sleep Disorders, U.S., 1990–2006

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^*Represents the average of 3-year visits around the given year.
Note: Primary and secondary diagnoses.
Source: National Ambulatory Medical Care Survey, NCHS.

Prevalence of Common Cardiovascular and Lung Diseases, U.S., 2007

*  Includes hypertension, CHD, stroke, or heart failure.
**  Hypertension is defined as systolic blood pressure ≥ 140 mmHg, or diastolic blood pressure ≥ 90 mmHg, or being on antihypertensive medication, or being told twice of having hypertension.
† Range from 650,000 to 1,300,000 (Am Heart J 2004;147:425–439).
‡  12,200,000 (2008) of these had an asthma attack in the past 12 months.
§  An estimated 12,000,000 diagnosed (2008) and 12,000,000 undiagnosed (2006).
Sources:  National Health and Nutrition Examination Survey (NHANES) of NCHS (2003–2006 data extrapolated to 2006) and National Health Interview Survey (NHIS) of NCHS.

Prevalence of Cardiovascular Diseases* in Adults by Age and Sex, U.S., 2003-2006

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^*  Hypertension, CHD, stroke, or heart failure. Hypertension is defined as systolic blood pressure ≥ 140 mmHg, or diastolic blood pressure ≥ 90 mmHg, or being on antihypertensive medication.
Source:  NHANES, 2003–2006, NCHS.

Prevalence of Common Cardiovascular and Lung Diseases by Age, U.S., 2006

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Source: NHIS and NHANES, NCHS.

Age-Adjusted Prevalence of Cardiovascular Disease Risk Factors in Adults, U.S., 1961–2006

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Notes: Hypertension is defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or being on antihypertensive medication. High cholesterol is ≥240 mg/dL. Overweight is BMI ≥25 kg/m³. Data were collected at six time periods: 1960–1961 (plotted at 1961), 1971–1974 (plotted at 1972), 1976–1980 (plotted at 1978), 1988–1994 (plotted at 1991), 1999–2004 (plotted at 2003), and 2005–2006 (plotted at 2006).
Sources: NHIS for smoking, ages ≥18, NCHS; NHANES for the other risk factors, ages 20–74, NCHS.

Hypertensive* Population Aware, Treated, and Controlled, Ages 18 and Older, U.S., 1976–1980 to 2003–2006

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^*  Hypertension is defined as systolic blood pressure ≥ 140 mm Hg, or diastolic blood pressure > 90 mm Hg, or being on antihypertensive medication.
Source:  NHANES, NCHS.

Adult Population With Hypertension* by Age, Race/Ethnicity, and Sex, U.S., 2003–2006

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^*   Hypertension is systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, or being on antihypertensive medication.
^** Non-Hispanic.
Sources:  NHANES, NCHS. 

Hospitalization Rates for Heart Failure, Ages 45–64 and 65 and Older, U.S., 1971–2006

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Source:  National Hospital Discharge Survey, NCHS.

Persons Experiencing Asthma Episodes in Previous 12 Months by Age, U.S., 1997–2008

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Source:  NHIS, NCHS.

Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2010

^* Direct costs are personal health care expenditures for hospital and nursing home care, drugs, home care, and physician and other professional services. The estimation method is based on Centers for Medicare & Medicaid Services (CMS) projections for total 2009 health expenditures by type of direct costs and NCHS estimates of direct costs in 1995 for each of the major diagnostic groups. The proportion of costs for 1995 for each diagnostic group is applied to the equivalent 2010 total by type of direct cost.
^** Morbidity costs were estimated for 2010 by multiplying NCHS estimates for 1980 by a 1980–2010 percent inflation factor derived from the increase in mean earnings estimated by the Bureau of the Census.
^†  The mortality cost for each disease group was estimated for 2009 by first multiplying the number of deaths in 2006 in each age- and sex-specific group by the 2005 present value of lifetime earnings (latest available) discounted at 3 percent; second, summing these estimates for each diagnostic group; and third, multiplying the estimates by a 2005–2010 inflation factor (1.194) based on change in mean earnings.
^‡ Costs of blood-clotting disease are estimated from predetermined proportions of CVD morbidity and mortality statistics for MI, cerebrovascular diseases, and diseases of arteries.
^§  Does not include lung cancer or leukemia.
Note: Numbers may not add to totals due to rounding.
Source: Estimates by NHLBI; data from the NCHS, the CMS, the Bureau of the Census, and the Institute for Health and Aging, University of California.

Total Economic Costs, U.S., 2010	Economic Costs of Cardiovascular, Lung, and Blood Diseases, U.S., 2010
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