4. Disease Statistics

• Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1987 and 2007
• Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2007
• Age-Adjusted 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., 2007
• Prevalence of Common Cardiovascular and Lung Diseases, U.S., 2008-2009
• Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2007

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 2007, cardiovascular, lung, and blood diseases accounted for 1,037,000 deaths and 43 percent of all deaths in the United States (p. 35). The estimated economic cost in 2007 for these diseases was $382 billion, 22 percent of the total economic costs of illness, injuries, and death (p. 52). Of all diseases, heart disease is the leading cause of death, cerebrovascular disease is third (behind cancer), and COPD (including asthma) ranks fourth (p. 38). Cardiovascular and lung diseases account for 3 of the 4 leading causes of death (p. 38) and 4 of the 10 leading causes of infant death (p. 44). Hypertension, heart disease, asthma, and COPD are especially prevalent and account for substantial morbidity in Americans (p. 47).

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 56,565 deaths in 2007 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.

Cardiovascular Diseases

• In 2007, CVD caused 814,000 deaths—34 percent of all deaths (p. 35).
• Heart disease is the leading cause of death; the main form, CHD, caused 406,000 deaths in 2007 (pp. 36, 38).
• The annual number of deaths from CVD increased substantially from 1900 to 1970 and remains high (p. 37).
• 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, for the first time, the rate was below the all-time low in 1900 (p. 37).
• Cerebrovascular disease, the third leading cause of death, accounted for 136,000 deaths in 2007 (pp. 36, 38).
• Heart disease is second only to all cancers combined in years of potential life lost (p. 38).
• 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 seventh (p. 38).
• Deaths with heart failure as the underlying or contributing cause increased from 1970 to 1993 and then remained constant to 2007 (p. 39).
• From 1999 to 2007, 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. 40).
• Because of the rapid decline in mortality from CHD since the peak in 1968, there were 1,137,000 fewer deaths from CHD in 2007 than would have occurred if there had been no decline (p. 41).
• Substantial improvements have been made in the treatment of CVD. Since 1975 or 1985, the percent of hospitalizations for AMI, stroke, heart failure, and cardiac dysrhythmias that were discharged dead declined appreciably (p. 41).
• 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. 42).
• From 1999 to 2007, the percentage decline in death rates for CHD and stroke was slightly greater for whites than for blacks (p. 43).
• In 2008, an estimated 82.6 million persons in the United States had CVD, including 76.4 million with hypertension and 16.3 million with CHD (p. 47).
• 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 1999–2004 and 2005–2008 (p. 48).
• From 1976–1980 to 2005–2008, 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. 49).
• A 2005–2008 national survey showed only about 48 percent of hypertensive patients (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or on antihypertensive medication) had their condition under control (p. 49).
• Hospitalization rates for heart failure in those aged 45 to 64 years increased from 1971 to 1993 and remained stable to 2007. Rates for those aged 65 years and older increased from 1971 to 1998 and remained relatively stable to 2007 (p. 50).
• The estimated economic cost of CVD for 2007 was $286 billion:
  • $167 billion in direct health expenditures
  • $119 billion in indirect cost of mortality (p. 52).

Lung Diseases

• Lung diseases, excluding lung cancer, caused an estimated 225,000 deaths in 2007 (p. 35).
• COPD caused 124,000 deaths in 2007 and is the fourth leading cause of death (pp. 36, 38).
• From 1999 to 2007, death rates for COPD and asthma decreased in both black and white men and women (p. 43).
• From 1980 to 2007, infant death rates for various lung diseases declined markedly (p. 43).
• Of the 10 leading causes of infant mortality, 4 are lung diseases or have a lung disease component (p. 44). From 1997 to 2007, changes in mortality for the causes were:
  • Congenital anomalies (-9 percent)
  • Disorders of short gestation (0.4 percent)
  • Sudden infant death syndrome (-30 percent)
  • Respiratory distress syndrome (-41 percent).
• About one in six deaths in children under 1 year of age is due to a lung disease (p. 44).
• From 1980 to 2007, the COPD death rate for women in the United States increased appreciably compared with the rates in several other countries (p. 45).
• From 1999 to 2007, 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. 46).
• Among the sleep disorders, sleep apnea is increasingly being recognized as an important health problem, which can lead to serious consequences. From 1990 to 2008, physician office visits for sleep apnea increased from 108,000 to 2.3 million (p. 46).
• Asthma is a common chronic condition, particularly in children (pp. 47, 48, 50).
• The economic cost of asthma, COPD, and pneumonia was $85 billion in 2007:
  • $66 billion in direct health expenditures
  • $19 billion in indirect cost of mortality (p. 51).

Blood Diseases

• Almost 10,000 deaths were attributed to blood diseases in 2007 (p. 35). These include the following:
  • 4,800 due to anemias
  • 1,800 due to coagulation defects
  • 800 due to purpura
  • 2,500 due to other blood diseases.
• A large proportion of deaths from AMI, cerebrovascular disease, and peripheral artery disease involve blood-clotting problems (no estimate available).
• In 2007, blood diseases cost the Nation's economy $10 billion:
  • $7 billion in direct health expenditures
  • $3 billion in indirect cost of mortality (p. 52).

Deaths From All Causes and Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 1987 and 2007

* Deaths from blood diseases not including blood-clotting disorders.
** Includes 12,589 CVD deaths due to pulmonary heart disease.
† Includes 12,490 CVD deaths due to pulmonary heart disease.
Note: Numbers may not sum to 100 percent due to rounding.
Source: Vital Statistics of the United States, National Center for Health Statistics (NCHS).

Deaths by Major Causes, U.S., 2007	Deaths From Cardiovascular, Lung, and Blood Diseases, U.S., 2007
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*Excludes 12,490 deaths from pulmonary heart disease (0.5%).	Note: Numbers may not sum to 100 percent due to rounding.

Deaths From Specific Cardiovascular, Lung, and Blood Diseases, U.S., 2007

* Most deaths from this cardiovascular disease can be classified as a blood-clotting disease. No good estimate is available.
** Deaths from pulmonary disorders also included as cardiovascular deaths.
† Deaths from anemias, coagulation defects, purpura, and other blood diseases. Deaths attributed to blood-clotting diseases classified to AMI, stroke, and peripheral artery disease are not included.
‡ Numbers may not sum to the total due to rounding.
Note: Total, excluding overlap, is 1,036,520.
Source: Prepared by the NHLBI from Vital Statistics of the United States, NCHS.

Deaths From Cardiovascular Diseases, U.S., 2007

Deaths From Cardiovascular Diseases, U.S., 2007	Deaths From Lung Diseases, U.S., 2007	Deaths From Blood Diseases, U.S., 2007
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* Includes heart failure, cardiac dysrhythmias, hypertensive disease, deep vein thrombosis, and other heart and blood vessel diseases.
Note: Numbers may not sum to 100 percent due to rounding.
Source: Prepared by the NHLBI from Vital Statistics of the United States, NCHS.

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

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Source: Vital Statistics of the United States, NCHS.

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

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*Not age-adjusted.
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)† 3.5 4.9 0.6 0.6 3.4 <0.1 0.6 0.2 0.3 0.3

* Includes 134.7 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., 2007

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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

*  ICD 10/9 comparability ratio (1.0502) applied.
** ICD 10/9 comparability ratio (1.0411) applied.
Source: Vital Statistics of the United States, NCHS.

Deaths Attributed to Heart Failure,* U.S., 1970–2007

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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 Coronary Heart Disease by Race/Ethnicity and Sex, U.S., 1999–2007

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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., 1999–2007

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

Age-Adjusted Death Rates for Coronary Heart Disease, U.S., 1950–2007
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 2007

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Source: National Hospital Discharge Survey, NCHS.

Death Rates* for Coronary Heart Disease in Men, Ages 35–74, in Selected Countries, 1970–2008

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* Age-adjusted to the European Standard Population.
Source: World Health Organization (WHO) Mortality Database.

Death Rates* for Coronary Heart Disease in Women, Ages 35–74, in Selected Countries, 1970–2008

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* Age-adjusted to the European Standard Population.
Source: WHO Mortality Database.

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

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Source: Vital Statistics of the United States, NCHS.

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

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Source: Vital Statistics of the United States, NCHS.

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

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^* Congenital CVD and congenital respiratory diseases accounted for 47.0 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 28 percent; congenital anomalies of the respiratory system declined 44 percent; other congenital anomalies increased 19 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., 2007

Cause of Death	Deaths Under Age 1	Text-only with data points
All Causes	29,138
Cardiovascular Diseases	2,241
Congenital Anomalies	1,617
Other	624
Lung Diseases	5,022
Sudden Infant Death Syndrome	2,453
Respiratory Distress Syndrome	789
Pneumonia	209
Bronchopulmonary Dysplasia (BPD)	201
Atelectasis of Newborn	366
Congenital Anomalies	410
Other Lung Diseases	594
Other Diseases	21,875

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, 1980–2008

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* Age-adjusted to the European Standard Population.
Source: WHO Mortality Database.

Death Rates* for Chronic Obstructive Pulmonary Disease, including Asthma, in Women, Ages 35 and Older, in Selected Countries, 1980–2008

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* Age-adjusted to the European Standard Population.
Source: WHO Mortality Database.

Age-Adjusted Death Rates for Chronic Obstructive Pulmonary Disease* by Race/Ethnicity and Sex, U.S., 1999–2007

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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., 1990–2008

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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., 2008-2009

*  Includes hypertension, CHD, stroke, or heart failure for ages 20 years and older.
**  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 for ages 18 years and older (Am Heart J 2004;147:425–439).
‡  24,567,000 still have asthma and of those, 12, 600,000 have had an attack in the past 12 months, for all ages.
§  An estimated 14,800,000 diagnosed (2009) and 12,000,000 undiagnosed (2006), for ages 18 years and older.
Sources: National Health and Nutrition Examination Survey (NHANES) 2005–2008, NCHS and National Health Interview Survey (NHIS) 2009, NCHS.

Prevalence of Cardiovascular Diseases* in Adults by Age and Sex, U.S., 2005-2008

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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, 2005–2008, NCHS.

Prevalence of Common Cardiovascular and Lung Diseases by Age, U.S., 2008–2009

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Source: NHIS and NHANES, NCHS.

Age-Adjusted Prevalence of Cardiovascular Disease Risk Factors in Adults, U.S., 1961–2009

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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 2004), and 2005–2008 (plotted at 2008).
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 2005–2008

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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., 2005–2008

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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., 1971–2007

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Source: National Hospital Discharge Survey, NCHS.

Persons Experiencing Asthma Episodes in Previous 12 Months by Age, U.S., 1997–2009

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Source: NHIS, NCHS.

Economic Cost Estimates

The economic cost estimates presented on pages 51 and 52 are not comparable to those in the FY 2009 Fact Book due to the following changes:

• The estimates of direct costs in the table on page 52 are obtained from the Medical Expenditure Panel Survey (MEPS) of the Agency for Healthcare Research and Quality (AHRQ) Web site. They replace estimates for previous years that were based on recent projections of total healthcare expenditures from the Centers for Medicare and Medicaid Services (CMS) for which the breakdown into the major diagnostic groups was based entirely on an increasingly out-of-date cost analysis for 1995.
• For analogous reasons, the estimates of indirect morbidity costs are being discontinued starting with the FY 2010 Fact Book.
• All estimates in the table on page 50 are for 2007. Direct and indirect costs are no longer projected to the current year.

MEPS estimates offer the following advantages:

• The estimates are based on a nationally representative, person-level survey that links health care costs directly to patient care events and specific medical conditions.
• They are readily available on the Web, updated annually, and available with demographic breakdowns and standard errors.
• They are used extensively in scientific publications and reports.

MEPS estimates also have some disadvantages:

• They are based on the noninstitutionalized population (i.e., cost data pertaining to nursing homes are not included in the estimates).
• The scope of costs used to make the estimates is narrower than those within the CMS projections.
• The estimates are based on household reports that are subject to underreporting and misreporting.

Total Economic Costs of the Leading Diagnostic Groups, U.S., 2007

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Direct and Indirect Economic Costs of Illness by Major Diagnosis, U.S., 2007

^* Direct costs are personal health care expenditures for hospital and professional services care, prescribed medications, and home care reported by the MEPS, AHRQ, by diagnosis, excluding nursing home care costs and costs due to comorbidities.
^** The mortality cost for each disease group was estimated for 2007 by multiplying the number of deaths by age, sex, and cause of death in 2007 by the 2005 present value of lifetime earnings (latest available) discounted at 3 percent and projected to 2007 based on a 2005 to 2007 inflation factor measured from mean earnings reported by the U.S. Census Bureau.
^† Includes costs for COPD, asthma, and pneumonia.
Note: Estimates are not available for total lung diseases and blood clotting disorders.
Source: Prepared by NHLBI from direct costs on the MEPS Web site; numbers of deaths from NCHS; present value of lifetime earnings from the Institute for Health and Aging, University of California; and mean earnings from the U.S. Census Bureau.

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