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Transitions From Heart Disease to Cancer as the Leading Cause of Death in US States, 1999–2016

ORIGINAL RESEARCH — Volume 15 — December 13, 2018

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Figure 1.
Distribution, by state, of age-standardized state-specific mortality rate ratios (MRRs), calculated by dividing the mortality rate of heart disease by the mortality rate of cancer, among all ages, both sexes, and all races and ethnicities, United States, 1999–2016. A ratio of <1.0 indicates that cancer predominates, and a ratio of >1.0 indicates that heart disease predominates.

State Age-Standardized Mortality Rate Ratio by Calendar Yeara
‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09 ‘10 ‘11 ‘12 ‘13 ‘14 ‘15 ‘16
Alabama 1.44 1.39 1.37 1.40 1.39 1.36 1.34 1.32 1.23 1.23 1.21 1.23 1.22 1.22 1.25 1.26 1.31 1.28
Alaska 1.04 1.02 0.98 0.89 0.98 0.87 0.97 0.96 0.84 0.83 0.87 0.86 0.85 0.82 0.78 0.89 0.96 0.89
Arizona 1.24 1.20 1.19 1.20 1.17 1.13 1.16 1.10 1.04 1.06 1.02 0.95 1.01 0.98 0.96 0.96 0.98 1.02
Arkansas 1.34 1.35 1.35 1.33 1.28 1.21 1.20 1.22 1.14 1.17 1.14 1.14 1.12 1.16 1.13 1.19 1.20 1.25
California 1.39 1.32 1.30 1.30 1.29 1.24 1.20 1.21 1.12 1.11 1.05 1.03 1.05 1.02 1.03 0.99 1.02 1.02
Colorado 1.15 1.09 1.07 1.05 1.06 1.03 1.03 0.97 0.95 0.94 0.90 0.89 0.90 0.89 0.90 0.96 0.96 0.95
Connecticut 1.25 1.23 1.16 1.18 1.11 1.04 1.02 1.00 1.00 1.01 0.97 0.95 0.98 1.02 1.00 0.99 1.01 1.00
Delaware 1.21 1.29 1.18 1.23 1.23 1.14 1.17 1.08 1.06 0.95 1.02 0.95 0.97 0.95 1.00 1.01 1.00 0.96
Florida 1.30 1.25 1.26 1.23 1.20 1.16 1.12 1.08 1.04 1.01 0.98 0.98 0.95 0.96 0.96 0.99 0.99 1.00
Georgia 1.40 1.34 1.34 1.33 1.30 1.23 1.24 1.21 1.14 1.14 1.13 1.10 1.07 1.05 1.07 1.09 1.11 1.12
Hawaii 1.29 1.25 1.16 1.30 1.16 1.17 1.06 1.02 0.99 1.04 1.04 0.96 0.96 1.00 1.03 0.98 1.00 0.99
Idaho 1.18 1.19 1.20 1.19 1.11 1.11 1.05 1.05 1.01 0.94 0.98 1.00 0.99 0.99 0.93 0.98 1.02 1.06
Illinois 1.33 1.24 1.24 1.23 1.21 1.15 1.15 1.11 1.05 1.05 1.01 1.02 1.02 0.98 0.99 1.00 1.02 1.01
Indiana 1.30 1.27 1.23 1.20 1.20 1.17 1.14 1.12 1.07 1.04 1.03 1.02 1.01 1.02 1.04 1.02 1.03 1.05
Iowa 1.27 1.23 1.19 1.17 1.12 1.07 1.07 1.05 1.00 1.05 1.03 1.01 0.96 1.01 1.00 0.95 0.98 1.02
Kansas 1.23 1.25 1.16 1.18 1.15 1.09 1.04 1.03 1.01 1.01 0.95 0.96 0.93 0.94 0.96 0.94 0.96 1.00
Kentucky 1.39 1.33 1.29 1.28 1.25 1.18 1.17 1.14 1.06 1.09 1.05 1.01 1.05 1.03 1.02 1.01 1.01 1.05
Louisiana 1.31 1.27 1.24 1.22 1.25 1.19 1.23 1.17 1.18 1.16 1.16 1.16 1.10 1.12 1.14 1.16 1.18 1.24
Maine 1.11 1.09 1.06 0.98 0.99 0.94 0.91 0.90 0.91 0.89 0.84 0.80 0.82 0.81 0.87 0.87 0.88 0.88
Maryland 1.24 1.25 1.24 1.20 1.22 1.15 1.14 1.11 1.13 1.08 1.08 1.06 1.03 1.05 1.06 1.04 1.09 1.05
Massachusetts 1.11 1.05 1.06 1.02 1.04 0.99 0.96 0.92 0.93 0.93 0.89 0.88 0.86 0.85 0.89 0.88 0.91 0.90
Michigan 1.43 1.40 1.38 1.35 1.33 1.27 1.25 1.20 1.19 1.20 1.13 1.12 1.13 1.13 1.17 1.15 1.18 1.21
Minnesota 1.03 0.93 0.94 0.90 0.85 0.83 0.86 0.79 0.77 0.74 0.72 0.71 0.73 0.76 0.77 0.76 0.76 0.77
Mississippi 1.52 1.53 1.54 1.52 1.49 1.42 1.47 1.34 1.38 1.35 1.27 1.25 1.22 1.15 1.22 1.19 1.28 1.24
Missouri 1.45 1.39 1.32 1.34 1.31 1.24 1.20 1.17 1.15 1.16 1.11 1.09 1.10 1.06 1.09 1.10 1.14 1.15
Montana 1.10 1.06 1.00 1.01 1.06 0.97 0.93 0.95 0.96 1.06 0.95 0.96 0.95 0.97 1.00 0.95 0.99 1.06
Nebraska 1.24 1.17 1.14 1.16 1.11 1.08 1.02 0.95 0.95 0.96 0.93 0.92 0.90 0.89 0.92 0.90 0.98 0.91
Nevada 1.33 1.20 1.26 1.23 1.22 1.25 1.29 1.27 1.14 1.13 1.11 1.13 1.15 1.18 1.18 1.20 1.28 1.31
New Hampshire 1.16 1.15 1.20 1.11 1.12 1.04 1.00 0.98 0.96 0.94 0.89 0.91 0.85 0.87 0.94 0.92 0.92 0.92
New Jersey 1.29 1.31 1.24 1.25 1.22 1.19 1.18 1.11 1.07 1.09 1.06 1.07 1.05 1.07 1.09 1.07 1.11 1.10
New Mexico 1.26 1.14 1.22 1.13 1.15 1.13 1.14 1.13 1.06 1.01 1.03 0.99 1.02 1.00 1.01 1.01 0.99 1.08
New York 1.56 1.53 1.51 1.53 1.50 1.43 1.43 1.39 1.36 1.35 1.30 1.23 1.21 1.17 1.19 1.17 1.22 1.21
North Carolina 1.26 1.30 1.21 1.19 1.20 1.11 1.11 1.03 1.03 1.03 1.02 0.98 0.96 0.98 0.99 0.94 0.99 0.96
North Dakota 1.25 1.16 1.12 1.16 1.13 1.07 1.06 1.01 1.02 0.94 1.06 1.01 0.90 1.01 0.99 0.98 0.93 0.99
Ohio 1.33 1.32 1.31 1.25 1.22 1.17 1.17 1.11 1.05 1.08 1.00 1.02 1.03 1.03 1.06 1.05 1.09 1.07
Oklahoma 1.53 1.52 1.46 1.51 1.53 1.44 1.38 1.33 1.27 1.30 1.23 1.23 1.20 1.16 1.23 1.27 1.27 1.28
Oregon 1.04 1.00 0.98 0.98 0.96 0.91 0.91 0.89 0.88 0.85 0.82 0.79 0.78 0.78 0.83 0.82 0.85 0.87
Pennsylvania 1.34 1.31 1.28 1.26 1.23 1.19 1.17 1.10 1.08 1.09 1.06 1.03 1.04 1.01 1.05 1.04 1.06 1.07
Rhode Island 1.16 1.21 1.21 1.22 1.21 1.15 1.21 1.11 1.14 1.09 0.99 0.94 1.00 1.01 0.94 0.96 0.98 0.96
South Carolina 1.29 1.25 1.19 1.21 1.17 1.15 1.13 1.06 1.06 1.02 1.04 1.03 1.01 1.01 1.03 1.06 1.07 1.04
South Dakota 1.16 1.23 1.17 1.16 1.10 1.07 1.02 1.04 0.95 0.99 1.09 0.91 0.91 0.95 0.97 0.95 0.98 0.98
Tennessee 1.40 1.34 1.32 1.34 1.31 1.24 1.19 1.16 1.13 1.16 1.10 1.11 1.09 1.09 1.10 1.12 1.15 1.11
Texas 1.38 1.34 1.34 1.33 1.30 1.25 1.23 1.17 1.16 1.13 1.12 1.09 1.06 1.07 1.09 1.11 1.15 1.13
Utah 1.22 1.28 1.30 1.31 1.30 1.26 1.19 1.17 1.21 1.19 1.14 1.07 1.15 1.11 1.17 1.18 1.22 1.23
Vermont 1.07 1.16 1.14 1.13 1.11 1.07 1.03 1.03 0.86 0.94 0.92 0.84 0.86 0.91 0.92 0.93 0.92 1.00
Virginia 1.20 1.18 1.17 1.15 1.12 1.12 1.07 1.05 1.01 1.01 0.98 0.98 0.95 0.96 0.97 0.97 0.97 0.97
Washington 1.09 1.07 1.05 1.03 1.01 0.97 1.00 0.96 0.95 0.93 0.88 0.89 0.87 0.86 0.89 0.88 0.88 0.90
West Virginia 1.45 1.36 1.36 1.35 1.36 1.24 1.22 1.18 1.14 1.17 1.08 1.07 1.05 1.09 1.01 0.99 1.00 1.05
Wisconsin 1.25 1.24 1.17 1.15 1.13 1.06 1.04 1.01 0.97 0.97 0.96 0.95 0.93 0.97 0.96 0.96 0.98 0.98
Wyoming 1.17 1.17 1.09 1.21 1.07 1.12 1.11 1.10 1.04 1.10 1.05 0.98 1.02 1.08 1.03 1.15 1.14 1.12

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Figure 2.
Frequency of categories of state-specific mortality rate ratios (MRRs), calculated by dividing the mortality rate of heart disease by the mortality rate for cancer, among all ages, both sexes, and all races and ethnicities, United States, 1999–2016. Top, number of states in each category of MRR, by calendar year. Each cell represents 1 state. Bottom, summary statistics by calendar year.

Category Calendar Year
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
No. of states in each MRR category
>1.0 (heart disease predominates) 50 49 46 46 46 43 43 39 36 35 31 25 27 28 29 24 27 31
  ≥1.4 7 4 3 3 3 3 2 0 0 0 0 0 0 0 0 0 0 0
  1.3 to <1.4 11 12 10 10 6 1 2 4 2 3 0 0 0 0 0 0 1 1
  1.2 to <1.3 18 17 13 14 16 10 9 4 3 1 4 4 3 1 3 2 6 8
  1.1 to <1.2 8 9 15 15 16 19 17 18 12 11 8 6 6 8 7 10 8 6
  >1.0 to <1.1 6 7 5 4 5 10 13 13 19 20 19 15 18 19 19 12 12 16
<1.0 (cancer predominates) 0 1 4 4 4 7 7 11 14 15 19 25 23 22 21 26 23 19
  0.9 to <1.0 0 1 4 2 3 5 6 9 10 11 12 17 13 13 15 19 19 14
  0.8 to <0.9 0 0 0 2 1 2 1 1 3 3 6 6 8 7 4 6 3 4
  0.7 to <0.8 0 0 0 0 0 0 0 1 1 1 1 2 2 2 2 1 1 1
  <0.7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MRR summary statistic
Maximum 1.56 1.53 1.54 1.53 1.53 1.44 1.47 1.39 1.38 1.35 1.30 1.25 1.22 1.22 1.25 1.27 1.31 1.31
90th Percentile 1.44 1.39 1.37 1.35 1.35 1.27 1.27 1.24 1.20 1.19 1.15 1.15 1.15 1.16 1.18 1.19 1.22 1.24
75th Percentile 1.34 1.32 1.30 1.30 1.28 1.23 1.20 1.17 1.14 1.13 1.10 1.07 1.06 1.07 1.09 1.10 1.14 1.12
Median 1.26 1.25 1.21 1.21 1.20 1.15 1.14 1.10 1.05 1.05 1.03 1.00 1.01 1.01 1.01 0.99 1.01 1.03
25th Percentile 1.17 1.17 1.13 1.15 1.11 1.07 1.03 1.01 0.97 0.96 0.96 0.95 0.93 0.95 0.96 0.95 0.98 0.97
10th Percentile 1.09 1.07 1.05 1.01 1.02 0.97 0.97 0.95 0.92 0.93 0.88 0.87 0.86 0.86 0.89 0.89 0.91 0.90
Minimum 1.03 0.93 0.94 0.89 0.85 0.83 0.86 0.79 0.77 0.74 0.72 0.71 0.73 0.76 0.77 0.76 0.76 0.77

a In this tabular version, MRRs are rounded to 2 decimal places, such that some are listed as 1.00 when really, unrounded, they are either slightly <1.0 or slightly >1.0.

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