Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Alabama

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

Heart Disease Stroke All Cancers 

United States Alabama

250

200

150

100

50

0

300

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Alabama, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Alabama

Estimated Cancer Deaths, 2004 

Cause of death US AL

All Cancers 563,700 10,000

Breast (female) 40,110 740

Colorectal 56,730 900

Lung and Bronchus 160,440 3,090

Prostate 29,900 630

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US AL

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US AL

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 10,000 are expected 

in Alabama. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004. This figure includes 24,270 new 

cases that are likely to be diagnosed in Alabama. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Alabama, accounting 

for 13,207 deaths or approximately 29% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,998 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Alabama

Alabama’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Alabama BRFSS

 $186,244 

National Program of Cancer Registries

 Alabama Statewide Cancer Registry

$745,219

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Alabama Cardiovascular Health Coalition

 Alabama Stroke Task Force

 Delta States Stroke Consortium

 $696,000

Diabetes Control Program

 Alabama Diabetes Prevention and Control Program

 $300,000 

National Breast and Cervical Cancer Early Detection Program

 Alabama Department of Public Health Breast and Cervical Cancer Early Detection Program

$3,243,390 

National Comprehensive Cancer Control Program 

 Alabama Comprehensive Cancer Control Program

 $671,955 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Alabama Tobacco Prevention and Control Program

$1,118,560 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 University of Alabama at Birmingham

$933,277

Total $7,894,645

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Alabama, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Alabama that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Alabama’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

African American women from 200.3 per 100,000 in 1990 to 

175.8 per 100,000 in 2000. 

 A 13% decrease in the number of women older than age 50 

who reported not having had a mammogram (from 33.2% in 

1992 to 19.9% in 2002).

 Prevalence rates that were lower than corresponding national 

rates for self-reported overweight (34.8% in Alabama versus 

36.7% nationally) and for women older than age 18 who 

reported not having had a Pap smear (15.1% in Alabama 

versus 16.7% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Alabama in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Alabama Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Obesity and Overweight

Alabama is among the top seven most obese states in the 

nation. Data from the 2003 CDC Behavioral Risk Factor 

Surveillance System (BRFSS) indicate that approximately 

28.4% of adults in Alabama are obese (BMI of 30 or higher), 

and an additional 34.8% of adults are overweight. In Alabama, 

obesity and overweight are prevalent among all races, all adult 

age groups, and both genders. White males have the highest 

percentage of overweight in Alabama (42.9%), however 

African Americans in Alabama have the highest percentage of 

obesity (37.9% compared to 26.5% for whites). After adjusting 

for age, the death rate rankings for obesity-related diseases in 

Alabama are among the highest in the nation. Alabama ranks 

6th for heart disease, 9th for stoke, and 10th for diabetes.

Several factors cause obesity and overweight: food and 

nutrient consumption patterns, a lack of physical activity, and 

socioeconomic factors. In Alabama, the prevalence of obesity 

among persons with annual incomes at or below $15,000 

is 30.9%. In comparison, among persons with incomes at 

or above $75,000, 20.8% are obese. Looking at education, 

obesity occurs in 26.3% of adults with less than a high school 

education, compared to 18.5% among college graduates. 

Geographically, counties in the lower third of the state are 

more likely to have high percentages of adults at risk for 

obesity and obesity-related health problems.

These data indicate that obesity and overweight together create 

a significant public health challenge in Alabama. In a bold step, 

Alabama has targeted obesity and overweight in its Healthy 

Alabama 2010 plan as well as in the Alabama Cardiovascular 

Health State Plan. 

Text adapted from Obesity and Overweight in Alabama, 2003

and the 2001 Alabama Cardiovascular Health State Plan.

Disparities in Health

African Americans comprise approximately 12% of the 

U.S. population—roughly about 35 million people—and are 

dispersed throughout the country, with high concentrations in 

the Southeastern United States. African Americans experience 

health disparities in significant proportions. They tend to have 

higher rates of behavioral risk factors for chronic diseases as 

well as higher heart disease, stroke and cancer mortality rates.

African Americans make up approximately 25% of Alabama’s 

population and experience high rates of risk factors for heart 

disease and cancer and high heart disease and cancer death 

rates. Data from CDC’s 2003 BRFSS indicate that African 

Americans are less likely than whites to consume 5 or more 

servings of fruits and vegetables per day (21.1% versus 23.0%) 

and are less likely to participate in leisure-time physical 

activity than whites (61.9% versus 73.0%). African Americans 

are also more likely to be obese than whites (37.9% versus 

26.5%), more likely to have high blood pressure than whites 

(38.3% versus 32.2%), and more likely to report having been 

told that they have diabetes than whites (13.6% versus 7.1%).

Given the prevalence rates of the above risk factors for heart 

disease and stroke, it is not surprising that African Americans 

also have higher heart disease and stroke death rates than 

whites. From 1996 to 2000, African Americans in Alabama 

had a heart disease death rate of 670 per 100,000 compared to 

whites’ heart disease death rate of 593 per 100,000. From 1991 

to 1998, African Americans in Alabama had a stroke death rate 

of 180 per 100,000 compared to 124 per 100,000 for whites. 

Other Disparities

 Breast Cancer: In 2002, BRFSS data indicate that 

African American women had higher rates of breast cancer 

screening in the last 2 years (85.4%) than whites (78,8%); 

however in 2000, they had a higher breast cancer death 

rate than whites (29.9 per 100,000 compared to 25.9 per 

100,000).

 Cervical Cancer: Like breast cancer, 2002 BRFSS data 

indicate that African American women were more likely to 

report having had a Pap smear in the last 3 years (90.9%) 

than white women (83.2%), but from 1997 to 2001, African 

American women in Alabama had a higher cervical cancer 

death rate than white women (6.1 per 100,000 compared to 

2.5 per 100,000).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Healthy People 2010 Goals: Obesity and Overweight 

Health Indicators Baseline for

Alabama (1997)

Alabama 

2010 Target

Increase the proportion of adults 

who are physically active 17% 25%

Reduce the prevalence of 

overweight adults 35% 20%

Increase consumption of fruits 

and vegetables 17% 40%

Source: Healthy Alabama 2010
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Alaska

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Alaska, 1995 and 2001

1995 2001 1995 2001 1995 2001

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

(rates per 100,000) 

United States Alaska

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Alaska

Estimated Cancer Deaths, 2004 

Cause of death US AK

All Cancers 563,700 780

Breast (female) 40,110 +

Colorectal 56,730 80

Lung and Bronchus 160,440 220

Prostate 29,900 +

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US AK

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US AK

+ Represents fewer than 50 deaths.

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 780 are expected 

in Alaska. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 1,800 

new cases that are likely to be diagnosed in Alaska. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the second leading cause of death in Alaska, accounting for 603 deaths or approximately 20% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the fourth leading cause of death, accounting for 158 

deaths or approximately 5% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Alaska

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Alaska BRFSS

 $217,936 

National Program of Cancer Registries

Alaska Cancer Registry

$549,900

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

Take Heart Alaska

 $300,000

Diabetes Control Program

Alaska Diabetes Prevention and Control Program

 $450,000 

National Breast and Cervical Cancer Early Detection Program

Breast and Cervical Health Check

$1,683,924 

National Comprehensive Cancer Control Program 

Alaska Comprehensive Cancer Control Program

 $296,889 

WISEWOMAN

Southeast Alaska Regional Health Consortium

 Southcentral Foundation in Alaska 

$948,370

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Alaska Tobacco Prevention and Control Program

$1,099,712 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010)

Chugachmiut, Inc.

$300,000

Total $5,846,731

Examples of Alaska’s Prevention

Successes

 Lower mortality rates for heart disease, cancer, and stroke 

compared with national rates. 

 A 14.0% decrease in the number of Alaska women older 

than age 50 who reported not having had a breast exam, 

from 31.4% in 1992 to 17.7% in 2002. 

 Lower prevalence rates than the corresponding national rates 

for self-reported high blood cholesterol (27.6% in Alaska 

versus 33.1% nationally), high blood pressure risk (20.8% 

versus 24.8%), and diabetes (5.0% versus 7.1%).

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Alaska, FY 2003 

Alaska’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Alaska that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Alaska in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Alaska Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Cardiovascular Disease

Alaska, in comparison with other states, has one of the lowest 

death rates for cardiovascular disease (CVD), including heart 

disease and stroke. Alaska also is the only state for which heart 

disease is not the leading cause of death. However, of the 

approximately 3,000 Alaskans who will die this year, 800 to 

900 are likely to die of CVD.

Heart disease and stroke affect men differently than women in 

Alaska. In addition, American Indian/Alaska Natives (AI/ANs) 

and African Americans experience CVD disparities in Alaska. 

From 1996 to 2000, men in Alaska had a heart disease death 

rate of 487 per 100,000, compared with 333 per 100,000 for 

women. AI/AN men had the highest heart disease death rate 

(569 per 100,000) among men, and African American women 

had the highest heart disease death rate among women (434 

per 100,000). Unlike heart disease, women have higher stroke 

death rates than men. Between 1991 and 1998, women had a 

stroke death rate of 131 per 100,000, compared with 116 per 

100,000 for men. Among men and women, AI/ANs had the 

highest stroke death rate (133 per 100,000 for men and 177 

per 100,000 for women). 

Of the more than 46,600 hospitalizations in Alaska in 2001, 

about 11% were primarily for heart disease and stroke. In 2001 

in Alaska, the mean length of stay in the hospital for heart 

disease was 4.4 days, and for stroke it was 7.4 days. The 

average charge per hospital stay in Alaska in 2001 was 

approximately $37,174 for heart disease and $29,807 for 

stroke.

The Alaska Department of Health began receiving funds from 

CDC in 2002 to support a state heart disease and stroke 

prevention program. Alaska initiatives to reduce CVD prevalence include the Alaskan Cardiovascular Disease Prevention 

Plan, which encourages Alaskans to adopt healthy lifestyle 

choices such as physical activity and a low-fat diet. The 

program also coordinates the state-level Take Heart Alaska 

Coalition, which works to increase heart health among all 

Alaskans by advocating for individual, worksite, communitybased commitment to healthy lifestyles and improving access 

to preventive services. Additionally, the program has partnered 

with the Rural Health Program to develop prevention and 

follow-up protocols for cholesterol and blood pressure in rural 

clinics. 

Text adapted from The Burden of Cardiovascular Disease in Alaska: 

Mortality, Hospitalization and Risk Factors (2004). 

Disparities in Health

American Indians and Alaska Natives make up 14% of Alaska’s 

population. In addition to having higher prevalence rates 

for risk factors for heart disease and stroke—poor nutrition, 

physical inactivity, obesity, and smoking—more AI/ANs in 

Alaska die from heart disease and stroke than whites. 

A 2001 report from the Alaska Department of Health and 

Social Services, Division of Public Health provided data 

from CDC’s Behavioral Risk Factor Surveillance System that 

highlighted the health disparities experienced by the state’s 

AI/AN population. From 1991 to 1998, AI/ANs in Alaska 

were more likely than whites to report inadequate leisure time 

physical activity (59% of AI/ANs, compared with 49% of 

whites) and were less likely to consume 5 or more servings 

of fruits and vegetables per day (19% of AI/ANs, compared 

with 24% of whites). Based on these two risk factors, AI/ANs 

in Alaska were also more likely to be overweight than whites 

(36% versus 29%). From 1991 to 1998, AI/ANs also had 

higher smoking rates than whites (42% versus 25%).

Given the above disparities in risk factors for chronic diseases, 

the differences between whites and AI/ANs in heart disease 

and stroke death rates are not surprising. From 1996 to 2000, 

AI/ANs in Alaska had a heart disease death rate of 468 per 

100,000, compared with 408 per 100,000 for whites. This 

heart disease death rate was also higher than the national heart 

disease death rate for AI/ANs (352 per 100,000). From 1991 to 

1998, the stroke death rate for AI/ANs (158 per 100,000) was 

higher than the rate for whites (118 per 100,000). As with heart 

disease, the stroke death rate for AI/ANs in Alaska was also 

higher than the stroke death rate for AI/ANs nationally (79 per 

100,000).

The AI/AN population in Alaska also experiences higher 

cancer death rates than their white counterparts. From 1990 

to 1998, AI/ANs had a cancer death rate of 204 per 100,000, 

compared with the rate for whites, 163 per 100,000.

Other Disparities

 Diabetes: From 1991 to 1998, African Americans in Alaska 

had higher rates of diabetes (6.1%) than Hispanics (3.7%), 

AI/ANs (3.5%), whites (3.3%) and Asian/Pacific Islanders 

(1.6%). 

 Prostate Cancer: From 1990 to 1998, African American 

men had a prostate cancer death rate that was more than 

twice as high as the rate for white men (48 per 100,000 

versus 22 per 100,000).

Opportunities for Success 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Arizona

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Arizona

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Arizona, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Arizona

Estimated Cancer Deaths, 2004 

Cause of death US AZ

All Cancers 563,700 9,710

Breast (female) 40,110 740

Colorectal 56,730 960

Lung and Bronchus 160,440 2,550

Prostate 29,900 510

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US AZ

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US AZ

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 9,710 are expected 

in Arizona. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 23,560 

new cases that are likely to be diagnosed in Arizona. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Arizona, accounting for 

10,588 deaths or approximately 26% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the fourth leading cause of death, accounting for 2,480 

deaths or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Arizona

Arizona’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Arizona BRFSS

 $159,239 

National Program of Cancer Registries 

 Arizona Cancer Registry

 $324,980 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program

 Arizona Diabetes Council

 $243,927 

National Breast and Cervical Cancer Early Detection Program 

 Well Woman Health Check

 $2,108,851 

National Comprehensive Cancer Control Program 

 Arizona Comprehensive Cancer Control

 $148,834 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Arizona Tobacco Prevention and Control

 $101,031 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Arizona Promoting Lifetime Activity for Youth (PLAY)

 Awards Program

 WELL AZ

 Eat and Play the Native Way

 $321,253 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $3,408,115 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Arizona, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Arizona that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Arizona’s Prevention 

Successes

 Statistically significant decreases in cancer deaths across all 

races from 1990 to 2000 (247.4 per 100,000 in 1990 versus 

213.1 per 100,000 in 2000 for men; 161.7 per 100,000 in 

1990 versus 151.8 per 100,000 in 2000 for women). 

 A 14.5% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 33.3% in 1992 to 18.8% in 2002). 

 A lower prevalence rate than the corresponding national rate 

for individuals who had been told they are at risk for high 

blood pressure (22.7% in Arizona versus 24.8% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Arizona in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Arizona Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight: Cancer

After heart disease, cancer is the second leading cause of 

death in Arizona. Most cancer cases affect adults in middle 

age; about 80% of all cases in Arizona are diagnosed at age 

55 and older. The rates for breast, colon, lung and bronchus, 

rectal, and prostate cancer are similar to national trends—they 

account for more than half of Arizona’s cancer burden. 

Between 1995 and 2000, these cancers accounted for 60% of 

the 19,716 new cases diagnosed in Arizona and 40% of the 

8,503 cancer deaths in the state. The overall cancer incidence 

rate in Arizona is 409.2 per 100,000, and the overall death rate 

in Arizona is 177.3 per 100,000. The American Cancer Society 

estimates that about one third of the cancer deaths expected to 

occur in 2004 will be related to nutrition, physical inactivity, 

obesity, and other preventable lifestyle factors. For the majority 

of Americans who do not use tobacco products, nutrition 

and physical activity are the most important modifiable 

determinants of cancer risk. 

Cancer Risks

Physical Activity: Arizona has experienced success in 

increasing rates of physical activity. According to 2003 

data from the Behavioral Risk Factor Surveillance System 

(BRFSS), 21.2% of Arizonans reported that they engage in 

no leisure time physical activity, compared with 51.3% in 

1998. To continue this trend, Arizona has implemented several 

programs to further encourage physical activity, including 

P.L.A.Y. (Promoting Lifetime Activity for Youth), a teacherdirected program that encouragesfourth through eighth graders 

to participate in 60 minutes of daily, independent physical 

activity. Another program, W.E.L.L. (Walk Everyday & Live 

Longer), is a 4-week community-based intervention aimed at 

increasing physical activity among sedentary residents. 

Nutrition: Data indicate that the nutritional status of Arizonans 

is also a significant concern. For example, 2003 BRFSS data 

indicate that 37.0% of Arizonans had a body mass index 

greater than 25, which is considered overweight, and only 

22.9% of Arizona residents report eating 5 or more fruits and 

vegetables per day. To reverse these trends, Arizona has formed 

the Arizona Nutrition Network, a group of public and private 

organizations that is using a social marketing campaign to 

promote healthy eating habits to lower-income Arizonans. 

Text adapted from Arizona Cancer Facts and Figures 2004-2005: A Source Book 

for Planning and Implementing Programs for Cancer Prevention and Control. 

Disparities in Health

Across the country, American Indians and Alaska Natives 

(AI/ANs) comprise more than 500 federally recognized tribes 

and represent 1% of the U.S. population. Compared with other 

racial and ethnic minorities, AI/ANs have the highest poverty 

rate, 26%, which is twice the national rate. In addition to high 

poverty levels, AI/ANs are experiencing increasing health 

disparities. 

Arizona’s AI/ANs, who represent 5% of the state’s population, 

also experience significant disparities in comparison with other 

ethnic groups. In Arizona, the average age at death for AI/ANs 

is 55, compared with 72 for whites. The leading causes of 

death for AI/ANs are heart disease and cancer, the same as for 

other populations. According to data from the Indian Health 

Service, in Arizona, heart disease was the cause of death for 

between 15.4% and 16.7% of AI/ANs in the Navajo, Phoenix, 

and Tucson areas between 1994 and 1996, followed by cancer 

(between 12.2% and 10.4%), diabetes (between 7.6% and 

5.6%), and alcohol-related illnesses (between 9.1% and 7.2%).

While these death rates for AI/ANs in Arizona are similar to 

national rates, Arizona’s AI/ANs are experiencing increasing 

death rates for these chronic diseases as other populations are 

seeing improvements. 

Text adapted from “Indian Health Care: Separate, Unequal,”

The Arizona Republic, April 14, 2002.

Other Disparities

 Diabetes: Hispanics (7.3%) are more likely to report having 

been told they have diabetes than whites (6.0%).

 Physical Activity: Hispanics (57.9%) are more likely 

to report not meeting the recommended guidelines for 

moderate physical activity than whites (49.3%).

 Heart Disease: The heart disease death rate for AI/ANs 

in Arizona is higher than the national rate of heart disease 

deaths for AI/ANs (403 per 100,000 in Arizona versus 352 

per 100,000 nationally). The heart disease death rate for 

Hispanics in Arizona is higher than the national rate of heart 

disease deaths for Hispanics (401 per 100,000 in Arizona 

versus 348 per 100,000 nationally). 

 Cervical Cancer: In Arizona, AI/ANs and Hispanics 

have higher cervical cancer death rates than whites (5.2 

per 100,000 for AI/AN women and 3.4 per 100,000 for 

Hispanic women, compared with 2.4 per 100,000 for white 

women). 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Arkansas

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Arkansas

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Arkansas, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Arkansas

Estimated Cancer Deaths, 2004 

Cause of death US AR

All Cancers 563,700 6,100

Breast (female) 40,110 380

Colorectal 56,730 630

Lung and Bronchus 160,440 2,060

Prostate 29,900 280

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US AR

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US AR

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 6,100 are expected 

in Arkansas. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 14,800 

new cases that are likely to be diagnosed in Arkansas. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Arkansas, accounting 

for 8,263 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,256 deaths 

or approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Arkansas

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Arkansas, FY 2003 

Arkansas’ Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Arkansas BRFSS

 $117,882 

National Program of Cancer Registries

 Arkansas Cancer Registry

 $687,319

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Arkansas Chronic Illness Collaborative

 Arkansas Wellness Coalition

 The Delta States Stroke Consortium

 $300,000

Diabetes Control Program

 Arkansas Diabetes Prevention and Control Program

$306,133 

National Breast and Cervical Cancer Early Detection Program 

 Arkansas Breast and Cervical Cancer Early Detection Program

$2,390,475 

National Comprehensive Cancer Control Program

 Cancer Control Team

 $409,509

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Arkansas Tobacco Prevention & Control Program

$970,397

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,181,715

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Arkansas that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Arkansas’ Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African Americans (436.6 per 100,000 in 1990 

versus 380.1 per 100,000 in 2000). 

 A 10% decrease in the number of individuals age 18 and 

older who reported having no leisure time activity (37.4% 

in 1996 versus 27.4% in 2002).

 Prevalence rates for nonsmoking among African Americans 

and Hispanics that were higher than the corresponding 

national rate (61.0% for African Americans and 61.5% for 

Hispanics in Arkansas versus 52.0% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Arkansas in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Arkansas Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight: Cardiovascular 

Disease and Preventable Risk Factors 

In 2001, Arkansas had the 9th highest heart disease death rate in 

the nation and the highest stroke death rate. From 1996 to 2000, 

the heart disease death rate in Arkansas was 583 per 100,000, 

compared with the national rate of 536 per 100,000. From 1991 

to 1998, the stroke death rate was 163 per 100,000, compared 

with the national rate of 121 per 100,000. 

This increased burden of disease is most probably explained by 

the higher prevalence of cardiovascular risk factors in the state’s 

population. Data from the Behavioral Risk Factor Surveillance 

System (BRFSS) for 2003 show that obesity rates doubled from 

13.2% in 1991 to 25.2% in 2003. In 2003 the percentage of 

adult obesity in Arkansas (25.2%) was higher than the rate of 

adult obesity for the entire United States (22.8%). Data from the 

BRFSS for 2003 indicate that when compared with the United 

States as a whole, more adults in Arkansas were at risk for high 

blood pressure (30.5% in Arkansas versus 24.8% nationally) 

and more were physically inactive (29.1% in Arkansas versus 

23.1% nationally). 

In addition to overweight and obesity, diet can affect the level 

of blood cholesterol, a major risk factor for heart disease. To

reduce the prevalence of these risk factors, Arkansas has created 

initiatives such as the Arkansas 5-A-Day Coalition’s Worksite 

Challenge and has established the Child Health Advisory 

Committee to encourage healthy eating and physical activity, 

and to combat childhood obesity. 

Text adapted from Cardiovascular Disease in Arkansas: 

Mortality, Costs, Disparity, and Risk Factors (June 2002)

Disparities in Health 

African Americans make up approximately 15.7% of Arkansas’ 

population and, as do most African Americans in the United 

States, experience health disparities in significant proportions. 

Nationally, and in Arkansas, African American women, in 

particular, have higher rates of death attributed to breast and 

cervical cancer than other racial and ethnic groups. 

Although African American women in Arkansas are more 

likely than white women to have had a mammogram in the 

last 2 years (82.0% for African Americans versus 79.7% for 

whites), in 2000, the breast cancer death rate was higher for 

African American women than for white women (38.3 per 

100,000 versus 21.2 per 100,000 for white women). The same 

holds true for cervical cancer screening and cervical cancer 

death rates. African American women are more likely to report 

having had a Pap smear in the last 3 years (86.5% of African 

American women versus 79.7% of white women), but they 

have higher rates of death from cervical cancer. From 1990 

to 2000, the cervical cancer death rate for African American 

women in Arkansas was 136% higher than the cervical cancer 

death rate for white women (7.8 per 100,000 for African 

American women versus 3.3 per 100,000 for white women). 

Between 1996 and 2000, African American women in Arkansas 

also had a higher heart disease death rate than white women 

(601 per 100,000 for African American women versus 455 per 

100,000 for white women). In addition, the death rate for stroke 

between 1991 and 1998 was higher among African American 

women than among white women (207 per 100,000 for African 

American women versus 151 per 100,000 for white women). 

Other Disparities

 Diabetes: African Americans have the highest rates of 

diabetes in Arkansas. Almost 10% of African Americans 

have been told they have diabetes, compared with 7.1% of 

whites and 6.7% of Hispanics.

 Physical Activity: In Arkansas, more African Americans 

report not meeting the recommended guidelines for 

moderate physical activity than whites (64.2% for African 

Americans versus 53.4% for whites). 

 Obesity: African Americans report higher rates of obesity 

than whites (35.5% for African Americans versus 24.1% for 

whites). 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Smoking

20%

0

40%

60%

80%

100%

Obese 

(BMI 30+)

<5 Fruits and 

Vegetables

Physically 

Inactive

Source: Arkansas Bureau of Vital Statistics

US AR Healthy People 2010 

Prevelance of Cardiovascular Disease Behavior Risk Factors 

BRFSS, 2000
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

California

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States California

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and California, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States California

Estimated Cancer Deaths, 2004 

Cause of death US CA

All Cancers 563,700 55,340

Breast (female) 40,110 4,060

Colorectal 56,730 5,360

Lung and Bronchus 160,440 14,450

Prostate 29,900 3,010

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US CA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US CA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 55,340 are expected in 

California. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 134,300 

new cases that are likely to be diagnosed in California. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in California, accounting 

for 68,234 deaths or approximately 29% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 18,088 deaths 

or approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States California

California’s Chronic Disease Program Accomplishments

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for California, FY 2003 

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 California BRFSS

 $267,679 

National Program of Cancer Registries

 California Cancer Registry

 $3,982,898 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

 Regents of the University of California, SF (Not verified) $790,000 

Diabetes Control Program

 Diabetes Coalition of California

 $990,320 

National Breast and Cervical Cancer Early Detection Program

 Every Woman Counts

 $8,397,307 

National Comprehensive Cancer Control Program

 Cancer Control Planning and Research

 $150,000 

WISEWOMAN

 California WISEWOMAN Program

 $1,001,265 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

California Tobacco Control Program

 $330,711 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) 

 Community Health Councils of Los Angeles, Inc.

 Harbor-UCLA Research and Education Institute

 University of California, San Francisco

 San Francisco Department of Public Health

 Special Services for Groups, Inc.

$914,451

$895,588

 $915,697

 $885,000

 $250,000 

Total $19,770,916

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in California that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of California’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women of all races, with the greatest decrease 

occurring among African American men (355.9 per 100,000 

in 1990 versus 300.6 per 100,000 in 2000). 

 A 10% decrease in the number of women older than age 50 

who reported not having had a mammogram in the last 2 

years (from 28% in 1992 to 18% in 2002).

 A lower prevalence rate than the corresponding national 

rate for individuals who currently smoke (16.8% in 

California versus 22.0% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to California in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

California Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Obesity and Healthy Weight

As in the rest of the country, obesity is a problem in California. 

According to CDC’s Behavioral Risk Factor Surveillance 

System (BRFSS) data, in 1990, less than 10% of adults in the 

state were obese (9.8%). By 2003, that rate had more than 

doubled to 23.2%. In addition, 36.2% of adults were overweight. 

Risk factors for obesity include poor nutrition and physical 

inactivity, areas in which adults in California could improve. 

In 2003, BRFSS data indicate that 22.3% of adults did not 

participate in any leisure time physical activity in the month prior 

to the survey. In addition, 73.1% of adults in the state did not 

consume more than 5 servings of fruits and vegetables per day. 

The obesity problem, however, is not limited to adults. A study 

by the California Center for Public Health Advocacy analyzed 

2001 fitness data for the state’s youth (kindergarten through 

12th grade) and found that over one quarter of the youth were 

overweight (26.5%). The study also found that 39.6% of youth 

in California were not physically fit. Hispanic and African 

American children were the most likely to be affected by 

childhood obesity. Over one third of Hispanic youth (33.7%) 

were overweight and 44.5% were not physically fit, compared 

with 28.6% of African American youth who were overweight 

and 46.0% who were not physically fit. About one fifth of white 

youth were overweight (20.2%) and over one third (33.5%) were 

not physically fit. 

The California Department of Health Services works to prevent 

and reduce obesity and has identified seven strategies as the most 

promising for reducing obesity and overweight. These strategies 

are to: 

 Increase rates of physical activity;

 Decrease physical inactivity, especially television watching 

by children;

 Increase the consumption of fruits and vegetables;

 Increase the initiation of breastfeeding, and prolong its 

duration;

 Decrease the consumption of high calorie, low nutrient foods;

 Decrease rates of food insecurity and hunger; and

 Improve access to prevention, early intervention, and 

treatment strategies for overweight and obesity in the health 

care system.

Text adapted from The Prevalence of Obesity and 

Healthy Weight in California Counties, 2001.

Disparities in Health

African Americans, who comprise approximately 12% of the 

U.S. population—about 35 million people—experience health 

disparities in significant proportions. They have higher stroke 

death rates than other groups as well as a higher prevalence of 

the risk factors for heart disease. Compared with other racial 

and ethnic minority groups, African Americans are more likely 

to develop lung, cervical, colorectal, and prostate cancer at 

disproportionate levels. 

African Americans make up approximately 7% of California’s 

population. The leading causes of death among African 

Americans in California are heart disease and cancer. Between 

1996 and 2000, the rate for heart disease among African 

Americans was higher than the heart disease death rate of their 

white counterparts (678 per 100,000 compared with 513 per 

100,000). Additionally, in 2000, both African American men 

and women were more likely to die from cancer than their 

white counterparts. The cancer death rate for African American 

men was 300.6 per 100,000, compared with 220.9 per 100,000 

for white men; the cancer death rate for African American 

women was 196.6 per 100,000, compared with 164.1 per 

100,000 for white women.

Data from the Behavioral Risk Factor Surveillance System 

show that African Americans in California are more likely than 

whites to be smokers (28.4% versus 16.2%). Compared with 

white Californians, African Americans are also more likely to 

be diagnosed with high blood pressure (45.6% versus 25.9%), 

more likely to report inadequate physical activity (33.1% 

versus 15.9%), and are more likely to report a diagnosis of 

diabetes (15.3% versus 6.0%). Additionally, the diabetes death 

rate for African Americans in California (42.3 per 100,000) is 

twice as high as the rate for whites (20.6 per 100,000).

Other Disparities

 Obesity: African Americans are more likely to classify 

themselves as obese (41.6%) than their white counterparts 

(20.0%). 

 Prostate Cancer: Prostate cancer death rates are higher 

among African American men (60.0 per 100,000) than 

among white men (27.7 per 100,000). 

 Breast Cancer: African American women are less likely to 

have a mammogram and are more likely to die from breast 

cancer (35.6 per 100,000) than white women (26.7 per 

100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Colorado

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Colorado

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Colorado, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Colorado

The Leading Causes of Death and Their Risk Factors

Estimated Cancer Deaths, 2004 

Cause of death US CO

All Cancers 563,700 6,390

Breast (female) 40,110 480

Colorectal 56,730 620

Lung and Bronchus 160,440 1,610

Prostate 29,900 330

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US CO

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US CO

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 6,390 are expected 

in Colorado. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 15,510 

new cases that are likely to be diagnosed in Colorado. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Colorado, accounting 

for 6,293 deaths or approximately 22% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the fourth leading cause of death, accounting for 1,825 deaths 

or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Colorado

Colorado’s Chronic Disease Program Accomplishments

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Colorado, FY 2003 

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

Colorado BRFSS

 $228,488 

National Program of Cancer Registries

 Colorado Cancer Registry

$676,914

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Colorado Cardiovascular Coalition

 Cardiovascular Disease and Stroke Prevention Program

 Stroke Advisory Board

 Colorado Cardiovascular Health State Plan 2010

 $298,102

Diabetes Control Program

 Colorado Diabetes Prevention and Control Program

 Buddy System

 $1,274,098 

National Breast and Cervical Cancer Early Detection Program 

 Colorado Women’s Cancer Control Initiative

$4,142,290 

National Comprehensive Cancer Control Program

 Colorado Comprehensive Cancer Prevention and Control Program

 $711,246 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Colorado State Tobacco Education and Prevention Partnership (STEPP)

$835,474 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Shape Up Across Colorado

 National Employee Health & Fitness Month

 Walk to School Colorado

 Colorado On The Move

$421,044 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $8,587,656 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Colorado that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Colorado’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among Hispanic men (240.2 per 100,000 in 1990 

versus 183.7 per 100,000 in 2000) and Hispanic women 

(133.2 per 100,000 in 1990 versus 119.1 per 100,000 in 2000). 

 A 6.8% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years, from 28.1% in 1992 to 21.3% in 2002.

 A lower prevalence rate than the corresponding national rate 

for women older than age 18 who reported not having had 

a Pap smear in the last 3 years (15.4% in Colorado versus 

16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Colorado in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Colorado Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight: 

Cardiovascular Disease

Although 2001 CDC mortality data indicate that Colorado had 

the 3rd lowest heart disease death rate in the nation and the 15th 

lowest stroke death rate, cardiovascular disease (CVD), including 

heart disease and stroke, was the leading cause of death in the 

state. From 1996 to 2000, Colorado had a heart disease death rate 

of 403 per 100,000, compared with the national average of 536 

per 100,000. From 1991 to 1998, Colorado had a stroke death 

rate of 112 per 100,00, compared with the national average of 

121 per 100,000. While the death rates in Colorado have been 

declining over the last 2 decades, the number of lives lost to 

CVD has increased due to Colorado’s aging population.

Each year between 1990 and 2001, there were more than 20,000 

CVD hospitalizations for men and 17,000 CVD hospitalizations 

for women in Colorado. Hospitalizations increase with age, 

peaking for 65- to 74-year-olds. 

In Colorado, the fiscal impact of CVD hospitalizations is high—

and has been rising. The cost per hospitalization for CVD rose 

from about $11,000 in 1990 to more than $25,000 in 2001. The 

total cost of all hospitalizations for which CVD was the primary 

diagnosis was nearly $400 million in 1990, and this cost rose to 

nearly $1.2 billion by 2001 (see figure below).

The Colorado Cardiovascular Health Program seeks to decrease 

the mortality and morbidity of CVD. The program aims to 

reduce CVD risk factors such as high blood cholesterol, high 

blood pressure, obesity, and diabetes and strives to encourage 

physical activity, fruit and vegetable consumption, and the 

cessation of tobacco use. 

Text adapted from Colorado Cardiovascular Health State Plan 2010 (November 2002).

Disparities in Health

Nationally, the health disparities that exist within the African 

American, Hispanic, and American Indian/Alaska Native 

(AI/AN) populations, when compared with other racial/ethnic 

groups, are strikingly apparent in life expectancy, deaths from 

chronic diseases, and other measures of health status. Many 

factors contribute to health disparities within these three 

populations, such as socioeconomic factors, discrimination, 

cultural barriers, and the lack of access to health care.

In Colorado, these groups comprise 25% of the state’s 

population. Although the state’s data on health status indicate 

that overall, Colorado is a healthy state, African Americans, 

Hispanics, and AI/ANs are disproportionately affected by 

disease, injury, disability, and death. In contrast, whites and 

Asian/Pacific Islanders in Colorado have many positive health 

indicators. 

From 1996 to 2000, Colorado’s African Americans had a higher 

death rate from heart disease than whites (466 per 100,000 for 

African Americans versus 405 per 100,000 for whites). An 

examination of cancer data over a 5-year period during the 

1990s indicate that African Americans had the lowest percentage 

of early detection for cancer (48.8%), compared with Hispanics 

(50.8%) and whites (57.6%).

Other Disparities

 Life Expectancy: In 1999, Colorado’s African Americans 

had a life expectancy that was 5 fewer years than the life 

expectancy for whites (73.1 years versus 78.1 years). 

 Cancer Deaths: In Colorado, from 1995 to 1999 incidence 

rates were statistically highest among whites, but death 

rates were statistically higher for African Americans. The 

death rate for African American men was 286.1 per 100,000 

compared with 226.1 per 100,000 for white men. The death 

rate for African American women was 176.3 per 100,000 

compared with 155.6 per 100,000 for white women. 

 Cervical Cancer: The cervical cancer incidence rate among 

Colorado’s Hispanic women (16.2 per 100,000) is more than 

twice as high as the rate for white women (7.4 per 100,000). 

 Diabetes: In Colorado, the diabetes death rate for African 

Americans is more than twice that of whites (34.0 per 

100,000 versus 16.0 per 100,000), but Hispanics have 

the highest diabetes death rate (35.9 per 100,000), which 

is almost 2.5 times the rate for whites. The death rate for 

AI/ANs (27.7 per 100,000) is approximately 1.7 times that 

of whites. 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

1990

$200 M

Total Cost 

0

*Not adjusted for inflation.

Source: Colorado Hospital Association, 2002

19911992199319941995199619971998199920002001

$400 M

$600 M

$800 M

$1 B

$1.2 B

Total Cost* for All Hospital Discharges That Listed Major CVD as 

Primary Diagnosis: Colorado Residents, 1990-2001
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Connecticut

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Connecticut

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Connecticut, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Connecticut

Estimated Cancer Deaths, 2004 

Cause of death US CT

All Cancers 563,700 7,010

Breast (female) 40,110 530

Colorectal 56,730 660

Lung and Bronchus 160,440 1,850

Prostate 29,900 430

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US CT

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US CT

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 7,010 are expected 

in Connecticut. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 17,010 

new cases that are likely to be diagnosed in Connecticut. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Connecticut, accounting 

for 8,582 deaths or approximately 29% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,003 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Connecticut

Connecticut’s Chronic Disease Program Accomplishments

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Connecticut, FY 2003 

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Connecticut BRFSS

 $244,376 

National Program of Cancer Registries $0

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Connecticut Cardiovascular Health Program

 $215,000

Diabetes Control Program

 Connecticut Diabetes Prevention and Control Program

 $378,513 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Program

$1,327,206 

National Comprehensive Cancer Control Program

 Division of Health Education Intervention

 $150,000 

WISEWOMAN

Stay Healthy For Life

$725,332

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Connecticut Tobacco Prevention and Control Program

$883,111 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $3,923,538 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Connecticut that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Connecticut’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among African Americans (368.7 per 100,000 in 

1990 versus 343.9 per 100,000 in 2000). 

 A 13.4% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 28.9% in 1992 to 15.5% in 2002).

 A prevalence rate that was lower than the corresponding 

national rate for women older than age 18 who reported 

not having had a Pap smear in the last 3 years (14.4% in 

Connecticut versus 16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Connecticut in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Connecticut Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Cardiovascular Disease 

Cardiovascular disease (CVD), including heart disease and 

stroke, is a serious public health concern in Connecticut. In 

2001, approximately 72% of all heart disease deaths occurred 

among people over the age of 75, and factoring in stroke deaths 

increases this number to slightly above 90%. However, CVD 

does not affect only the elderly; it is also the second leading 

cause of premature death in adults between the ages of 45 and 

75. Although CVD is presumed to primarily affect men, 53% of 

Connecticut’s total CVD deaths are among women.

CVD poses a significant economic burden on the state. It is the 

most expensive medical condition, accounting for one seventh 

of the state’s total health care spending. The state’s estimated 

annual cost for coronary heart disease is $1.2 billion; for stroke, 

$500 million; and for congestive heart failure, $500 million. 

To address these problems, the staff of the Connecticut 

Department of Public Health’s CVD program provides 

technical assistance to, and oversight of, more than 30 local 

health departments and other community agencies that receive 

funding for programs to reduce CVD risk factors in their 

residents. 

In addition, the state has set several Healthy People 2010 goals 

related to cardiovascular disease, including reducing the ageadjusted death rate for coronary heart disease from 177 to 166 

per 100,000 by 2010, and reducing the age-adjusted death rate 

for stroke from 50 to 48 per 100,000 by 2010. 

Text adapted from Connecticut Department of Public Health Issue Brief #2002-1: 

Cardiovascular Disease, Connecticut’s Leading Killer (February 2002).

Disparities in Health

African Americans, who make up about 9% of the population 

in Connecticut, have high risk factor prevalence rates for heart 

disease, stroke, and cancer—and high death rates for these 

diseases.

Risk factors for heart disease, stroke, and cancer include poor 

nutrition, physical inactivity, obesity, smoking, high blood 

pressure, and diabetes. According to 2003 data from CDC’s 

Behavioral Risk Factor Surveillance System, only 24.0% of 

African Americans in Connecticut reported consuming 5 or more 

servings of fruits or vegetables per day, compared with 30.5% 

of whites. In addition, 30.3% of the state’s African Americans 

reported that they did not participate in any leisure time physical 

activity during the past month, compared with 18.4% of whites. 

As a result of these behaviors, Connecticut’s African Americans 

have higher rates of obesity than whites (32.5% versus 18.0%). 

African Americans are also more likely to smoke (20.9%, 

compared with 18.1% of whites), and are more likely to report 

having been told by a doctor that they have high blood pressure 

(35.6%, compared with 25.4% of whites). 

Given the high prevalence rates of the above risk factors, it is not 

surprising that African Americans in Connecticut have higher 

heart disease and stroke death rates than whites. From 1996 to 

2000, African Americans had a heart disease death rate of 575 

per 100,000, compared with 494 per 100,000 for whites. From 

1991 to 1998, African Americans also had a higher stroke death 

rate (121 per 100,000) than whites (101 per 100,000).

African Americans in Connecticut also have higher cancer 

death rates than whites. In 2000, the cancer death rate among 

African American men in Connecticut was 343.9 per 100,000, 

compared with 227.8 per 100,000 for white men. That same 

year, Connecticut’s African American women had a cancer death 

rate of 184.3 per 100,000, compared with 162.8 per 100,000 for 

white women. 

Other Disparities

 Diabetes: In 2001, African Americans in Connecticut had 

a higher diabetes death rate than whites (46.5 per 100,000 

versus 18.1 per 100,000).

 Cervical Cancer: Although 2002 data indicate that 

African American women were more likely to have had a 

mammogram in the last 3 years than white women (11.9% 

versus 13.3%), from 1997 to 2001, African American women 

had a higher cervical cancer death rate than white women (3.4 

per 100,000 versus 1.8 per 100,0000).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Kidney Disease 2%

Heart Disease 

and Stroke 44%

Cancer 30%

Respiratory

Disease 6%

HIV 1%

Motor Vehicle

Accidents 1%

Alzheimer’s

Disease 2%

Suicides, Homicides,

and Firearms 3%

Diabetes 3%

Liver Disease 1% Accidents 4%

Pneumonia and 

Influenza 3%

Major Causes of Death in Connecticut, 2001

Source: American Heart Association, 2004

Connecticut State Fact Sheet
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

District of Columbia

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States District of Columbia

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and District of Columbia, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States District of Columbia

Estimated Cancer Deaths, 2004 

Cause of death US DC

All Cancers 563,700 1,180

Breast (female) 40,110 110

Colorectal 56,730 130

Lung and Bronchus 160,440 280

Prostate 29,900 80

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US DC

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US DC

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 1,180 are expected 

in the District of Columbia. About 1.4 million new cases of 

cancer will be diagnosed nationally in 2004 alone. This figure 

includes 2,860 new cases that are likely to be diagnosed in 

District of Columbia. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in the District of Columbia, 

accounting for 1,761 deaths or approximately 30% of the 

District’s deaths in 2001 (the most recent year for which data are 

available). Stroke is the third leading cause of death, accounting 

for 265 deaths or approximately 4% of the District’s deaths 

in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. A key 

strategy for addressing these risk factors is to educate the public 

and health care practitioners about the importance of prevention. 

All people should also partner with their health care providers to 

have their risk factor status assessed, monitored, and managed 

in accordance with national guidelines. People should also be 

educated about the signs and symptoms of heart attack and 

stroke and the importance of calling 911 quickly. Forty-seven 

percent of heart attack victims and about the same percentage of 

stroke victims die before emergency medical personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States District of Columbia

District of Columbia’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 DC BRFSS

 $208,587 

National Program of Cancer Registries

 DC Cancer Registry

$300,000

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 DC Cardiovascular Health Program

 $300,000

Diabetes Control Program

 DC Diabetes Prevention and Control Program

 $400,000 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Early Detection Program

$1,107,356 

National Comprehensive Cancer Control Program

 Comprehensive Cancer Control Program

 $95,061 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

DC Tobacco Prevention and Control Program

$354,774 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) 

National Black Women’s Health Project

$936,535

Total $3,702,313 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for 

District of Columbia, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in District of Columbia that fall into other health areas. A listing of these programs can be 

found at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of the District of Columbia’s 

Prevention Successes

 Statistically significant decreases in cancer deaths among 

African American men (425.9 per 100,000 in 1990 versus 

378.7 per 100,000 in 2000). 

 A 7.7% decrease in the number of women in DC older than 

age 50 who reported not having had a mammogram in the 

last 2 years, from 23.3% in 1992 to 15.6% in 2002.

 Lower prevalence rates than the corresponding national 

rates for self-reported overweight (31.9% in the District of 

Columbia versus 36.7% nationally) and for women older 

than age 18 who reported not having had a Pap smear in 

the last 3 years (12.4% in the District of Columbia versus 

16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding needed to implement effective chronic disease prevention programs 

and ensure that all Americans have access to quality health care. 

CDC funding and support enable state health departments to 

respond efficiently to changing health priorities and effectively 

use limited resources to meet a wide range of health needs 

among specific populations. The table below is a breakdown 

of the CDC’s funding awards to the District of Columbia in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

District of Columbia Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Heart Disease and Stroke

Heart disease and stroke pose serious public health concerns 

for residents of the District of Columbia. In 2001, total heart 

disease and stroke death rates were above the national rates for 

these diseases. Mortality data from the CDC indicate that in 

2001 the District of Columbia had the 2nd highest heart disease 

death rate in the nation (308.5 per 100,000 in D.C. versus 

246.8 per 100,000 nationally), but was among the lowest in 

the nation for stroke deaths (46.4 per 100,000 versus 57.7 

nationally). Heart disease remains the leading cause of death in 

the District of Columbia, particularly for African Americans. 

The graph below illustrates the major causes of death in the 

District of Columbia. 

Data from the CDC indicate that a disproportionate number of 

heart disease deaths occur among African Americans, a trend 

that is consistent with national trends. CDC data indicate that 

from 1996 to 2000, the District’s African American residents 

had an age-adjusted death rate for total cardiovascular diseases 

of 625 per 100,000, compared with 395 per 100,000 for their 

white counterparts. 

The District of Columbia has taken steps to increase awareness 

among residents of the importance of healthy lifestyle choices 

and has set several objectives to reduce heart disease and 

stroke. The District’s Healthy People 2010 plan emphasizes 

reducing the prevalence of preventable behaviors such as 

promoting healthy eating habits and exercise, controlling blood 

pressure and blood cholesterol, and reducing tobacco use. 

Disparities in Health

African Americans, who comprise approximately 12% of the 

U.S. population—about 35 million people—experience health 

disparities in significant proportions. Even with a strong focus by 

the District of Columbia health department on preventing racial 

and ethnic health disparities in the District of Columbia, 2003 

data from the Behavioral Risk Factor Surveillance System show 

that the city is still experiencing health disparities, especially 

between African Americans and whites. In the District of 

Columbia, when compared with other groups, African Americans 

are more likely to report physical inactivity, poor nutrition, high 

blood pressure, and smoking—all of which are risk factors for 

developing chronic diseases such as cardiovascular disease, 

cancer, and diabetes. 

In 2003, only 26.4% of the District’s African Americans 

consumed 5 or more servings of fruits and vegetables per day, 

compared with 35.7% of whites. In addition, African Americans 

in the District were more likely to report not meeting the 

recommended guidelines for moderate physical activity (57.5% 

of African Americans, versus 33.4% of whites). The percentage 

of African Americans who have been told that they had 

high blood pressure is more than double that of their white 

counterparts (33.5% versus 15.0%).

Smoking is also more prevalent among African Americans than 

among whites in the District of Columbia. In 2003, 19.0% of 

African Americans smoked daily, in comparison with 7.3% of 

whites. This disparity in smoking rates is associated with the 

disparities in cancer death rates—in the District of Columbia in 

2000, the cancer death rate was higher among African Americans 

(378.7 for men and 216.4 for women per 100,000) than among 

whites (202.9 for men and 136.9 for women per 100,000).

Other Disparities

 Heart Disease: In the District of Columbia, heart disease 

death rates from 1996 to 2000 were higher for African 

Americans (625 per 100,000) than for whites (395 per 

100,000) and Hispanics (102 per 100,000). 

 Stroke: From 1991 to 1998, the death rate for stroke was 

higher for the District of Columbia’s African Americans than 

for whites (132 per 100,000 versus 93 per 100,000).

 Lung Cancer: In the District of Columbia in 2000, the lung 

cancer death rate was more than twice as high for African 

Americans men in the District of Columbia (94.2 per 100,000) 

than for white men (37.8 per 100,000 for whites).

Major Causes of Death in the District of Columbia, 2001

Adapted from The District of Columbia Healthy People 2010 Plan: 

A Strategy for Better Health (September 2000)

Kidney Disease 2%

Heart Disease and 

Stroke 40%

Cancer 27%

Suicides,

 Homicides, and 

 Firearms 8%

Motor Vehicle 

Accidents 1%

Alzheimer’s

Disease 2%

Accidents 5%

Liver

Disease 1%

HIV 5%

Pneumonia and Influenza 2%

Diabetes

4%

Respiratory Disease 3%
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Delaware

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Delaware

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Delaware, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Delaware

Estimated Cancer Deaths, 2004 

Cause of death US DE

All Cancers 563,700 1,810

Breast (female) 40,110 130

Colorectal 56,730 160

Lung and Bronchus 160,440 510

Prostate 29,900 90

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US DE

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US DE

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 1,810 are expected 

in Delaware. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 4,390 

new cases that are likely to be diagnosed in Delaware. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Delaware, accounting 

for 2,033 deaths or approximately 29% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 383 deaths or 

approximately 5% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Delaware

Delaware’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Delaware BRFSS

 $111,972 

National Program of Cancer Registries

 Delaware Cancer Registry

$271,288

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program

 Delaware Diabetes Prevention and Control Program

 $410,000 

National Breast and Cervical Cancer Early Detection Program 

 Screening For Life

$834,138 

National Comprehensive Cancer Control Program

 Cancer Prevention and Control Program

 $125,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Delaware Tobacco Prevention and Control Program

$794,493 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $2,546,891 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Delaware, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Delaware that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Delaware’s Prevention 

Successes

 Statistically significant decreases in cancer deaths for men 

across all races and for white women, with the greatest 

decrease occurring among African American men (496.1 

per 100,000 in 1990 versus 292.2 per 100,000 in 2000). 

 A 19.5% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 32.3% in 1992 to 12.8% in 2002).

 A lower prevalence rate than the corresponding national 

rate for women older than age 18 who reported not having 

had a Pap smear in the last 3 years (12.1% in Delaware 

versus 16.7% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Delaware in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Delaware Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Diabetes

Diabetes, a serious disease requiring extensive medical 

monitoring and lifelong treatment, is a common cause of 

disability and death in Delaware. Data from CDC’s Behavioral 

Risk Factor Surveillance System (BRFSS) and the National 

Health Interview Survey show that in 1998 approximately 

45,000 people in Delaware had diabetes—30,000 who had 

been diagnosed and 15,000 who were unaware that they had 

the disease. Data from the BRFSS for 2003 indicate that in 

Delaware, adults age 55 and over have higher rates of diabetes 

(15.2% to 16.2%) than the general population (7.7%). In 

addition, African Americans (10.7%) and Hispanics (10.3%) 

have higher rates of diabetes than whites (6.9%). More than 

2,500 Delaware women aged 18 to 44 were estimated to have 

had diabetes during pregnancy in 1998. Between 1995 and 1999, 

approximately 300 infants each year were born to mothers who 

had diabetes during pregnancy. 

Many adults in Delaware do not receive the appropriate testing 

and treatment for diabetes. For example, one quarter of Medicare 

beneficiaries with diabetes aged 65 to 74 did not receive glucose 

tests or dilated eye exams between 1998 and 1999, and 40% did 

not have tests for hyperlipidemia, even though Medicare covered 

all of these tests for people with diabetes. One third of Delaware 

residents with diabetes over age 18 did not have foot exams 

between 1997 and 1998. These treatments and tests can decrease 

the risk of serious complications from diabetes, including 

blindness, heart attacks, and foot and leg amputations.

From 1994 to 1999, diabetes was directly responsible for more 

than 5,000 hospitalizations in Delaware and it was implicated 

as a secondary diagnosis in almost 10 times as many cases. In 

1998, almost 10,000 Delawareans experienced diabetes-related 

disabilities and made more than 300,000 physician visits related 

to the disease.

Caring for people with diabetes is expensive. In the late 1990s, 

the total economic burden attributed to diabetes in Delaware 

was immense. Between 1995 and 1999, payments to Delaware 

hospitals for diabetes care were more than $100 million per year. 

During the same time, the average payment per hospitalization 

for diabetes patients was between $2,000 and $3,000 greater than 

the average payment for patients without the disease. In 1997, the 

annual total economic cost of diabetes in Delaware was estimated 

to be almost $300 million. 

Text adapted from The Burden of Diabetes in Delaware (2002).

Disparities in Health

Although Delaware is the one of the nation’s smallest states, it 

has very definite rural and urban populations. Sussex County, 

which is primarily rural, accounts for almost half of the state’s 

area and is one of the largest counties east of the Mississippi 

River. The total population for the county is 141,000. 

According to CDC mortality data, in 2001, Delaware had the 

4th highest cancer death rate (219.3 per 100,000) in the United 

States. In rural Sussex County, African Americans had higher 

cancer death rates than whites (280.9 per 100,000 compared 

with 205.1 per 100,000), and from 1995 to 1999, cancer death 

rates for the county’s whites declined, while the rates for 

African Americans remained stable. According to the 2001 

Delaware Vital Statistics Annual Report, the three leading 

causes of death in Sussex County were all preventable diseases. 

They include: heart disease, which accounted for 30.7% of 

deaths in Sussex County; cancer, which accounted for 25.7%; 

and stroke, which accounted for 4.7%.

In rural Sussex County, death rates for congestive heart 

failure exceed those of the entire state, and heart disease is the 

county’s most frequent cause for hospitalization. According 

to 2001 CDC mortality data, diabetes death rates for all racial 

and ethnic groups in Delaware exceeded diabetes death rates 

for the United States (27.1 per 100,000 compared with 25.2 

per 100,000), although the diabetes death rate in Sussex 

County was lower than the rate in Delaware (27.1 per 100,000 

compared with 29.5 per 100,000).

Other Disparities

 Physical Activity: Delaware’s Hispanics and African 

Americans are less likely to meet the recommended 

guidelines for moderate physical activity than whites 

(34.5% for Hispanics and 37.0% for African Americans, 

compared with 45.9% for whites).

 Obesity: African Americans are more likely to be obese 

(32.8%) than whites (22.4%) or Hispanics (28.1%).

 Cervical Cancer: In Delaware in 2002, African American 

women were more likely to have had a Pap smear in the last 

3 years (95.1%) than white women (91.0%); however, in 

2001 African American women in Delaware had a higher 

cervical cancer death rate (7.0 per 100,000) than white 

women (4.0 per 100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Florida

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

Chronic Diseases: The Leading Causes of Death

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Florida

350

400

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Florida, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Florida

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US FL

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Source: BRFSS, 2004

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Florida, accounting for 

50,629 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 10,414 

deaths or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003

Estimated Cancer Deaths, 2004 

Cause of death US FL

All Cancers 563,700 40,090

Breast (female) 40,110 2,480

Colorectal 56,730 3,840

Lung and Bronchus 160,440 12,360

Prostate 29,900 2,220

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US FL

Preventive Screening Trends, 2002

Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 40,090 are expected 

in Florida. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 97,290 

new cases that are likely to be diagnosed in Florida. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004
3

Profiling the Leading Causes of Death in the United States Florida

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Florida BRFSS

 $153,968 

National Program of Cancer Registries

 Florida Cancer Data System (FCDS)

$1,343,710

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Florida Cardiovascular Health Council

 $1,268,984

Diabetes Control Program

 Closing the Gap

 Indigent Insulin Program

 $647,183 

National Breast and Cervical Cancer Early Detection Program 

 Florida Breast and Cervical Cancer Early Detection Program

$4,045,728 

National Comprehensive Cancer Control Program

 Cancer Control and Research Advisory Council

 Florida Cancer Plan

 $187,331 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

Florida Tobacco Prevention and Control Program

$661,526 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Pedometer Loan Program

 PACE (Patient-centered Assessment nnd Counseling on Exercise)

$400,000 

Racial and Ethnic Approaches to Community Health (REACH 2010) 

 Florida International University

$915,089

Total $9,623,519 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Florida, FY 2003 

Florida’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Florida that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Florida’s Prevention 

Successes 

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among African American men (414.5 per 100,000 

in 1990 versus 312.3 per 100,000 in 2000). 

 A 16.9% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 36.3% in 1992 to 19.4% in 2002); for African 

American women older than age 50, the number decreased 

29.3% (from 50.5% in 1992 to 21.2% in 2002).

 A 2.8% decrease in the number of women older than age 18 

who reported not having had a Pap smear in the last 3 years 

(from 19.8% in 1992 to 17.0% in 2002). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Florida in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Florida Profiling the Leading Causes of Death in the United States

Disparities in Health

Hispanics are the fastest growing minority population in the 

country; in 2000 they comprised almost 17% of Florida’s 

population. Like other racial and ethnic minorities, Hispanics 

in Florida experience health disparities for some critical risk 

factors and chronic diseases, such as nutrition, physical activity, 

overweight and obesity, and heart disease. In other areas, such 

as diabetes, high blood pressure and stroke, Hispanics have 

better health status than other groups.

In 2003, CDC Behavioral Risk Factor Surveillance System 

(BRFSS) data indicate that African Americans (20.6%) and 

Hispanics (20.7%) were less likely to consume 5 servings of 

fruits and vegetables per day than whites (24.4%). Hispanics 

also had lower rates of participation in leisure time physical 

activity (61.8%, compared with 67.6% for African Americans 

and 75.4% of whites). Based on these risk factors, Hispanics 

were also more likely to be overweight than whites (41.7% 

versus 38.5%) and more likely to be obese than whites (21.6% 

versus 19.1%). From 1996 to 2000, Hispanics in Florida had a 

higher heart disease death rate than Hispanics nationally (369 

per 100,000 versus 348 per 100,000).

However, from 1991 to 1998, Hispanics had a lower stroke 

death rate (66 per 100,000) than whites (97 per 100,000) or 

African Americans (102 per 100,000). In addition, Hispanics in 

Florida had a lower stroke death rate than Hispanics nationally 

(66 per 100,000 versus 79 per 100,000). BRFSS data from 2003 

also indicate that Hispanics in Florida were less likely than 

whites to report having been told that they have diabetes (6.0%, 

compared to 8.6% for whites). 

The state of Florida passed a law in 2000 that provided funding 

for a grant program to begin to address disparities in health. 

Grants are provided to local counties and organizations with 

the intent to increase community-based health promotion and 

disease prevention activities. 

Other Disparities

 Diabetes: African Americans in Florida are more likely than 

whites to report having been told that they have diabetes 

(10.3% versus 8.6%). 

 Cervical Cancer: Although 2002 BRFSS data indicate that 

African American women were more likely to report having 

had a Pap smear in the last 3 years (13.4% versus 16.6%), 

from 1997 to 2001 African American women had a cervical 

cancer death rate that was more than twice that of white 

women (6.8 per 100,000 versus 2.9 per 100,000).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: Coronary Heart 

Disease, Stroke, and Diabetes

Despite more than 3 decades of declining cardiovascular 

disease (CVD) death rates, and despite rates of heart disease 

and stroke deaths that are lower than the national average, 

CVD remains the leading cause of death for men and women 

of all racial and ethnic groups in Florida. From 1996 to 2000, 

Florida had a heart disease death rate of 493 per 100,000, 

compared with the national rate of 536 per 100,000. From 

1991 to 1998, Florida had one of the lowest stroke death rates 

in the nation, at 102 per 100,000, compared with 121 per 

100,000 nationwide.

The elderly are not the only Florida residents affected by CVD. 

In 2000, there were nearly 5,000 heart attack deaths and more 

than 1,100 stroke deaths among Florida residents under the 

age of 65, and more than 71,000 hospital discharges for heart 

disease and stroke among those under the age of 65. During 

the same year, the age-adjusted stroke death rate for women 

was 44.9 per 100,000 population; for men, the rate was 51.2 

per 100,000. However, more women than men died of stroke 

each year in Florida (for example, 6,001 women versus 4,380 

men in 2000). The lower age-adjusted stroke death rate and 

higher number of stroke deaths for Florida women reflect the 

state’s larger population of older women.

Diabetes is an important modifiable risk factor for both 

coronary heart disease and stroke because the risk of CVDrelated death is 2 to 4 times greater for persons with the 

disease. In Florida, an estimated 1 million adults have diabetes 

that has been diagnosed and an estimated 300,000 have 

diabetes and are unaware of their disease status. Florida’s 

diabetes prevalence remained stable from 1987 to 1997 (at 

approximately 5.6%), but increased to 6.9% in 2000. 

The Florida Department of Health began receiving funds 

from CDC in 2002 to support a state heart disease and stroke 

prevention program. In addition to developing a state plan for 

action, the Florida Department of Health’s Cardiovascular 

Health Program competitively provides funds for county 

health departments to implement community-based 

intervention programs. The program also promotes statewide 

public/private partnerships that address cardiovascular health, 

women and heart disease, physical activity, nutrition, obesity 

prevention, tobacco avoidance, and diabetes.

Text adapted from Florida Cardiovascular Surveillance Summary 

and State Plan for Action (2001).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Georgia

Chronic Diseases: The Leading Causes of Death

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Georgia

The Leading Causes of Death

United States and Georgia, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Georgia

Estimated Cancer Deaths, 2004 

Cause of death US GA

All Cancers 563,700 14,600

Breast (female) 40,110 1,130

Colorectal 56,730 1,320

Lung and Bronchus 160,440 4,660

Prostate 29,900 740

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US GA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US GA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 14,600 are expected 

in Georgia. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 35,430 

new cases that are likely to be diagnosed in Georgia. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Georgia, accounting for 

17,478 deaths or approximately 27% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 4,312 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Georgia

Georgia’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Georgia BRFSS

 $194,501 

National Program of Cancer Registries 

 Georgia Comprehensive Cancer Registry

 $906,121 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Georgia Cardiovascular Health Program

 $1,000,000 

Diabetes Control Program 

 Georgia Diabetes Advisory Council

 Diabetes Today Program

 $350,000 

National Breast and Cervical Cancer Early Detection Program 

 Comprehensive Breast and Cervical Screening Program

 $4,305,057 

National Comprehensive Cancer Control Program 

 Georgia Cancer Coalition

 $881,442 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Georgia Tobacco Prevention and Control Program

 $1,431,023 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Georgia Golden Olympics

 Georgia Striders Program

 Mayor’s Walk

 Osteoporosis Prevention

 Park Promotion

 Take Charge of Your Health

 Take Charge Challenge

 Kids Walk to School Day

 $407,956 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Fulton County Department of Health and Wellness 

 $903,949 

Total $10,380,049

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Georgia, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Georgia that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Georgia’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African Americans (397.7 per 100,000 in 1990 versus 

339.2 per 100,000 in 2000). 

 A 21.2% decrease in the number of women older than age 50 

who reported not having had a mammogram (from 41.9% in 

1992 to 20.7% in 2002).

 Lower prevalence rates than the corresponding national rates 

for women older than age 18 who reported not having had a 

Pap smear in the last 3 years (13.1% in Georgia versus 16.7% 

nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Georgia in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Georgia Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Overweight and Obesity

The rising prevalence of overweight and obesity in adults and 

children is an increasing health concern in Georgia and across the 

United States. Contributing factors to the recent rise in 

overweight and obesity rates are poor diet and lack of physical 

activity. Data from CDC’s Behavioral Risk Factor Surveillance 

System (BRFSS) indicate that between 1990 and 2003 the 

prevalence of overweight and obesity in Georgia increased 

14.5%, from 45.6% to 60.1%.

The 2003 BRFSS data indicate that there is a relationship 

between the prevalence of overweight and obesity and the 

income and education levels of Georgia’s residents. In 2003, the 

percentage of obesity and overweight for Georgians earning less 

than $15,000 was 63.4% (26.9% were overweight and 36.5% 

were obese); the percentage for those earning $50,000 or more 

was 58.6% (36.8% were overweight and 21.8% were obese). 

Similarly, the percentage of obesity and overweight for 

Georgians with less than a high school diploma was 64.0% 

(32.3% were overweight and 31.7% were obese), and the 

percentage for Georgians who received a high school diploma or 

General Equivalency Diploma was 63.0% (36.2% were 

overweight and 26.8% were obese). In contrast, the percentage 

for Georgians with a college degree was 56.3% (36.7% were 

overweight and 19.6% were obese). 

In 2001, among Georgia’s youth, 29.7% of middle school 

students aged 11 to 14 were at risk for becoming overweight or 

were already overweight, while high school students aged 14 to 

18 had a slightly lower percentage of risk (26.7%). In both 

middle and high school, boys were more likely to be at risk for 

overweight or obesity than girls. Boys in middle school had the 

highest percentage of overweight and at risk for overweight 

(36.7%), compared with middle school girls (22.0%), high 

school girls (20.9%), and high school boys (32.7%).

In addition to being a risk factor for heart disease and stroke, 

overweight and obesity are also leading risk factors for diabetes. 

BRFSS data indicate that in 2003, 7.8% of adults in Georgia 

reported having been told that they have diabetes, compared with 

the national average of 7.1%.

Georgia has addressed the problem of overweight and obesity in 

the state by launching the Take Charge of Your Health Campaign 

to reduce the incidence of chronic disease by promoting healthy 

nutrition choices and increased physical activity. 

Text adapted from Overweight among Middle and 

High School Students in Georgia (2001).

Disparities in Health

African Americans, who comprise approximately 27% of 

Georgia’s population experience disproportionate health 

disparities. Nationally, African Americans have higher stroke 

mortality rates than other groups as well as higher prevalence 

of the risk factors for heart disease, stroke, and cancer. 

From 1996 to 2000, the heart disease death rate for African 

Americans in Georgia was 665 per 100,000, compared with 

559 per 100,000 for whites. The stroke death rate for the state’s 

African Americans was 191 per 100,000, compared with 134 

per 100,000 for whites. 

African Americans in Georgia also have higher cancer death 

rates. According to the Georgia Cancer Data Report 2000, 

African Americans were 27% more likely to die of cancer 

than their white counterparts. In 2000, the cancer death rate 

for African Americans in Georgia was 234.3 per 100,000, 

compared with 194.8 per 100,000 for whites. African American 

men had higher prostate and colorectal cancer death rates (81.0 

per 100,000 and 34.0 per 100,000, respectively) than their 

white counterparts (94.0 per 100,000, 36.8 per 100,000, and 

21.7 per 100,000, respectively). Similarly, African American 

women had higher breast and colorectal cancer death rates 

(31.1 per 100,000 and 23.6 per 100,000, respectively) than 

white women (24.4 per 100,000 and 15.1 per 100,000, 

respectively). 

These higher death rates for chronic diseases are influenced by 

high rates of behavioral risk factors as described below.

Other Disparities

 Overweight and Obesity: In Georgia, 68.2% of African 

Americans are either overweight (35.8%) or obese (32.4%), 

compared with whites (35.2% are overweight and 22.4% 

are obese).

 Physical Activity: Hispanics in Georgia are least likely to 

engage in physical activity (33.1%), compared with African 

Americans (27.6%) and whites (23.2%). 

 High Blood Pressure: In Georgia, African Americans are 

more likely to report having been told that they have high 

blood pressure (31.3%) than whites (27.4%) or Hispanics 

(15.7%).

 Diabetes: African Americans are more likely to have been 

told that they have diabetes (9.5%), compared with whites 

(7.1%) and Hispanics (3.9%). 
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Hawaii

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Hawaii

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Hawaii, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Hawaii

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US HI

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US HI

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Estimated Cancer Deaths, 2004 

Cause of death US HI

All Cancers 563,700 2,090

Breast (female) 40,110 140

Colorectal 56,730 200

Lung and Bronchus 160,440 530

Prostate 29,900 130

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 2,090 are expected 

in Hawaii. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 5,070 

new cases that are likely to be diagnosed in Hawaii. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Hawaii, accounting 

for 2,310 deaths or approximately 28% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 766 deaths or 

approximately 9% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Hawaii

Examples of Hawaii’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decreases 

occurring among white males (262.1 per 100,000 in 1990 

versus 243.7 per 100,000 in 2000) and white females (187.9 

per 100,000 in 1990 versus 149.8 per 100,000 in 2000). 

 A 3.2% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 29.7% in 1992 to 26.5% in 2002). 

 A lower prevalence rate than the corresponding national 

rate for self-reported obesity (16.4% in Hawaii versus 

22.8% nationally). 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Hawaii, FY 2003 

Hawaii’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Hawaii BRFSS

 $90,579 

National Program of Cancer Registries $0

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Hawaii Diabetes Control and Prevention Program 

 $355,414 

National Breast and Cervical Cancer Early Detection Program

 Hawaii Breast and Cervical Cancer Control Program

 $1,014,518 

National Comprehensive Cancer Control Program 

 Hawaii Comprehensive Cancer Control Program

 $103,408 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Hawaii Tobacco Prevention and Education Project

 $745,339 

State Nutrition and Physical Activity/Obesity Prevention Program (No CDC Funding) $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $2,309,258 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Hawaii that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Hawaii in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Hawaii Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Heart disease continues to be the leading cause of death in the 

United States and in Hawaii. CDC mortality data for Hawaii 

indicate that in 2001, more than 2,300 people died of heart 

disease and more than 750 people died of stroke. That year, 

these conditions accounted for over 38% of all deaths in the 

state. 

Although Hawaii’s heart disease mortality rates are below the 

national average (404 per 100,000 versus 535 per 100,000), 

not all segments of the population have benefited equally from 

recent improvements in death rates. Analysis of cardiovascular 

disease mortality data in Hawaii from 1996 to 2000 shows that 

heart disease death rates for Asian/Pacific Islander men (530 

per 100,000), American Indian/Alaska Native men (707 per 

100,000) and Hispanic men (548 per 100,000) were higher 

than the rate for white men (473 per 100,000). 

In Hawaii, the stroke death rate from 1996 to 2000 (116 

per 100,000) was lower than the national average (121 per 

100,000). However, the stroke death rate for the state’s 

Asian/Pacific Islanders during that period (129 per 100,000), 

which was higher than the national rate for all races and higher 

than the national rate for Asian and Pacific Islanders (105 per 

100,000), has not shown any improvement since the early 

1980s. 

Although the prevalence of elevated cholesterol, high blood 

pressure, and smoking has decreased since the mid 1980s, they 

remain serious risk factors for much of the adult population in 

Hawaii. Data from CDC’s Behavioral Risk Factor Surveillance 

System (BRFSS) indicate that 27% of adults in Hawaii have 

been told they have high blood cholesterol, 23.2% have been 

told they have high blood pressure, and 17.2% are smokers. 

In addition, half of the adults in Hawaii (50.2%) do not meet 

the recommended guidelines for moderate physical activity 

and only 27.6% consume 5 or more servings of fruits and 

vegetables per day. Because of these risk factors, more than 

half of the adult Hawaiian population is either overweight 

(36.0%) or obese (17.1%). 

The Hawaii Department of Health recently implemented Start. 

Living. Healthy. This multimedia, public education campaign is 

designed to provide the people of Hawaii with information on 

how to adopt a healthy lifestyle, become physically active, eat 

nutritious foods, and live tobacco-free.

Disparities in Health

About 3.7% of the U.S. population consider themselves to be 

of Asian or Pacific Island descent, according to the 2000 U.S. 

Census. These data also indicate that Asian/Pacific Islanders 

(which include Native Hawaiians) represented 51% of the 

population in Hawaii, making it the state with the highest 

population of Asian/Pacific Islanders in the United States. 

According to CDC’s Behavioral Risk Factor Surveillance 

System 2003 data, Hawaiians are less likely to be diagnosed 

with high blood pressure (23.2%), less likely to be diagnosed 

with high cholesterol (27.0%), less likely to smoke (17.2%), 

and are more likely to engage in leisure time physical activity 

(81.7%). Despite these healthy indicators, Asian/Pacific 

Islanders generally experience poorer health than the general 

U.S. population. Asian/Pacific Islanders are more at risk for 

developing and dying from cancer, heart disease, diabetes, and 

other diseases. The leading causes of death among Asian/Pacific 

Islanders are heart disease, cancer, and stroke. Asian/Pacific 

Islanders in Hawaii have higher death rates for heart disease 

when compared with their white counterparts (414 per 100,000 

versus 387 per 100,000) and higher death rates for stroke when 

compared with their white counterparts (129 per 100,000 for 

Asian/Pacific Islanders versus 87 per 100,000 for whites). 

According to 2002 BRFSS data, Asian/Pacific Islander women 

aged 50 years or older are less likely than their white counterparts 

to report having had a mammogram in the last 2 years (28.6% 

for Asian/Pacific Islander women versus 24.3% for white 

women). Moreover, Asian/Pacific Islander women aged 18 years 

or older are less likely than their white counterparts to report 

having had a Pap smear in the last 3 years (19.1% for Asian 

Pacific Islander women versus 12.5% for white women). 

Other Disparities

 Smoking: In 2002, Asian/Pacific Islanders had higher rates 

of smoking (18.2%) than Asian/Pacific Islanders in the 

general U.S. population (13.7%); although their smoking 

rates were lower than whites (20.0%) and African Americans 

(21.9%) in Hawaii. 

 Overweight and Obesity: In 2002, Asian/Pacific Islanders 

in Hawaii were least likely to be overweight or obese 

(47.9%) as compared to African Americans (66.5%), Whites 

(50.1%), and Hispanics (49.1%) in Hawaii; although they 

were more likely to be overweight or obese when compared 

to Asian/Pacific Islanders in the general U.S. population 

(35.9%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Idaho

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Idaho

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Idaho, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Idaho

Estimated Cancer Deaths, 2004 

Cause of death US ID

All Cancers 563,700 2,250

Breast (female) 40,110 170

Colorectal 56,730 210

Lung and Bronchus 160,440 610

Prostate 29,900 140

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US ID

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US ID

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 2,250 are expected in 

Idaho. About 1.4 million new cases of cancer will be diagnosed 

nationally in 2004 alone. This figure includes 5,460 new cases 

that are likely to be diagnosed in Idaho. 

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Idaho, accounting for 

2,489 deaths or approximately 26% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 781 deaths or 

approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Idaho

Idaho’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Idaho BRFSS

 $159,813 

National Program of Cancer Registries 

 Cancer Data Registry of Idaho

 $155,366 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Diabetes Alliance of Idaho

 $350,000 

National Breast and Cervical Cancer Early Detection Program 

 Women’s Health Check

 $1,463,132 

National Comprehensive Cancer Control Program $0 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Idaho Tobacco Prevention and Control Program

 $1,020,418 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $3,148,729 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Idaho, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Idaho that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Idaho’s Prevention

Successes

 A lower prevalence rate than the corresponding national rate 

for current smokers (19% in Idaho versus 22% nationally) 

and lower lung cancer death rates for men (59.7 per 100,000 

in 2000) and women (34.5 per 100,000) than the national 

rates (76.9 per 100,000 for men nationally and 41.2 per 

100,000 for women nationally). 

 A 17.5% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 46.3% in 1992 to 28.8% in 2002). 

 A higher prevalence rate than the corresponding national 

rate for self-reported participation in leisure time physical 

activity (81.4% in Idaho versus 76.9% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Idaho in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Idaho Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Obesity 

Idaho’s adults are becoming increasingly overweight and 

obese. In 2003, 59.0% of adults in the state were either 

overweight (37.2%) or obese (21.8%). The percentage of 

Idaho adults who were obese rose 6.8% (from 15.0% in 

1994 to 21.8% in 2003). Similarly, the number of Idahoans 

who reported being diagnosed with diabetes increased 2.7% 

(from 3.6% in 1994 to 6.3% in 2003). According to the Idaho 

Department of Health and Welfare, overweight individuals 

with and without diabetes tend to suffer more health problems 

than those who are of normal weight. 

The prevalence of overweight, obesity, and diabetes increases 

with age. In Idaho, the obesity prevalence rate in 2003 was 

higher for each successive age group until age 64: for adults 

aged 18 to 24, the rate was 12.5%; for those aged 25 to 34, the 

rate increased to 18.8%. For adults aged 35 to 44, the rate was 

24.2%; for those aged 45 to 54, 26.4%; for those aged 55 to 65, 

27.4%; and among those aged 65 and older, the rate dropped 

to 21.5%. According to 2003 data from the Behavioral Risk 

Factor Surveillance System, 7.2% of Idahoans aged 45 to 54 

reported that they had been diagnosed with diabetes, compared 

with 11.6% of those aged 55 to 64, and 13.6% of those aged 65 

and over. In addition, CDC mortality data from 2001 indicate 

that the death rate from diabetes was higher in Idaho (26.2 per 

100,000) than it was nationally (25.2 per 100,000). 

There were also gender disparities for these conditions. Men 

in Idaho are more likely to have been diagnosed with diabetes 

than women (7.0% of men, compared with 5.6% of women). 

Obesity rates in Idaho also mirror this trend: men are more 

likely to be overweight than women (45.0% of men are 

overweight, compared with 28.8% of women), and they are 

slightly more likely to be obese than women (the obesity rate 

for men is 22.7%, compared with 20.8% for women). 

In an effort to reduce the risk associated with diabetes and 

other chronic diseases caused by overweight, obesity, and 

diabetes, the Idaho Diabetes Prevention and Control Program, 

in conjunction with the CDC and the National Diabetes 

Education Program, is launching programs to provide support 

to health care providers and their overweight patients.

Text adapted from Overweight, Obesity, and Diabetes in Idaho, Winter 2004.

Disparities in Health

Almost 20% of the U.S. population resides in rural areas. 

People in these areas have a higher risk of heart disease, 

diabetes, and cancer, which is attributable in part to a 

population that is older, sicker, poorer, and less educated. 

There are disparities in health status between rural and urban 

populations; in addition, there are disparities in infrastructure 

or professional capacity to address these health needs. For 

residents of rural areas, these disparities include a lack of 

access to health care professionals and health care services. 

Rural areas comprise 88.3% of the state of Idaho. These 

areas are home to 36.2% of the total population of the state. 

Throughout most of the 1990s, most rural areas in the state 

experienced growth, but substantial growth took place in 

areas that were adjacent to urban areas. The demographic 

makeup of the state is changing in two significant ways: youth 

are moving from rural areas and Hispanic populations are 

migrating to these areas. From 1997 to 1998, 15 counties in 

Idaho experienced population losses, which have resulted in 

an aging rural population that lives in areas that lack adequate 

health care facilities and support. The state may also face new 

disparities in the future—Idaho is approximately 88% white, 

however, at 9%, Hispanics are the state’s largest minority 

group, and this percentage is expected to grow. Data from 

CDC’s 2003 Behavioral Risk Factor Surveillance System 

indicate that almost 5.9% of Hispanics reported having been 

diagnosed with diabetes and 17.4% reported having been told 

that they have high blood pressure. While these rates are lower 

than the corresponding rates for whites (6.2% and 23.2%, 

respectively), they still represent potential health problems 

within the growing Hispanic population in Idaho.

Other Disparities

 Colorectal Cancer Screening: In 2002, 48.1% of women 

in Idaho reported that they used a fecal occult blood test to 

screen for colorectal cancer, compared with 42.5% of men.

 Diabetes: In Idaho, percentage of men who report they 

have been diagnosed with diabetes (6.4%) is higher than the 

percentage for women (5.8%). 

 Nutrition: In Idaho, 25.4% of women consume 5 or more 

servings of fruits and vegetables, compared with 15.3% of 

men.

 Obesity: Hispanics have higher obesity rates (27.4%) than 

whites (21.5%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Illinois

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Illinois

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Illinois, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Illinois

The Leading Causes of Death and Their Risk Factors

Estimated Cancer Deaths, 2004 

Cause of death US IL

All Cancers 563,700 24,840

Breast (female) 40,110 1,790

Colorectal 56,730 2,580

Lung and Bronchus 160,440 6,760

Prostate 29,900 1,290

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US IL

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US IL

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 24,840 are expected 

in Illinois. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 60,280 

new cases that are likely to be diagnosed in Illinois. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Illinois, accounting for 

30,990 deaths or approximately 29% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 7,230 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Illinois

Illinois’ Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Illinois BRFSS

 $191,983 

National Program of Cancer Registries

 Illinois State Cancer Registry

 $1,405,621 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 RUSH Presbyterian St. Luke’s Medical Center

 Illinois Cardiovascular Health Partnership

 $300,000

Diabetes Control Program

 Community Health and Diabetes Awareness Program

 $837,825 

National Breast and Cervical Cancer Early Detection Program 

 Illinois Breast and Cervical Cancer Early Detection Program 

 $3,232,605 

National Comprehensive Cancer Control Program

 Illinois Comprehensive Cancer Control Program

 $150,000 

WISEWOMAN 

 Women With Heart

 $1,000,000 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Illinois Tobacco Prevention and Control Program

 $1,618,423 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Legislative Fitness Day

 PE Curriculum Improvement/Equipment Distribution (Program Un-named)

 Women’s Health Grants Program

 Well Workplace Award Illinois Achievement Award Well City, USA Award Educational Programs

 $409,357 

Racial and Ethnic Approaches to Community Health (REACH 2010)

Access Community Health Network 

 Chicago Department of Health 

 University of Illinois at Chicago 

 $900,425

$908,806

$915,913 

Total $11,870,958 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Illinois, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Illinois that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Illinois’ Prevention

Successes

 Statistically significant decreases in cancer deaths among 

African American men (437 per 100,000 in 1990 versus 

368.8 per 100,000 in 2000). 

 A 12.2% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 35.3% in 1992 to 23.1% in 2002).

 A prevalence rate that was lower than the corresponding 

national rate for African American women older than age 

18 who reported not having had a Pap smear in the last 3 

years (9.2% in Illinois versus 11.0% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Illinois in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Illinois Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease and Obesity

More than 42,000 Illinois residents die annually from 

cardiovascular disease (CVD). Each year, more Illinois 

residents die from CVD than from the next six leading 

causes of death—cancer, unintentional injuries, lung disease, 

pneumonia, influenza, and diabetes—combined. Unfortunately, 

this trend does not appear to be reversing, as the number of 

annual deaths from CVD in Illinois has remained virtually 

unchanged for the last 10 years. 

Like much of the United States, in Illinois there is a disparity 

between whites and other racial and ethnic groups in CVD 

death rates. In Illinois, members of these groups die from CVD 

at a higher rate than their white counterparts. The death rates 

for these groups also consistently exceed the U.S. average for 

nonwhite CVD deaths. 

In addition, 88% of all Illinois residents possess at least one 

risk factor for CVD. Almost one third have two risk factors 

and 12% have three risk factors. One particularly damaging 

risk factor, obesity, is prominent in the state, and is related 

to the rates of physical inactivity and poor nutrition. At least 

3.6 million adult Illinois residents—66% of men and 57% 

of women—are mildly, moderately, or severely obese. Data 

from CDC’s 2003 Behavioral Risk Factor Surveillance System 

indicate that only 22.3% of adults in Illinois consumed 5 or 

more servings of fruits and vegetables per day and 25.3% of 

adults in Illinois were physically inactive. 

In Illinois, the financial costs of CVD and obesity are 

enormous. The state’s total inpatient hospital charges for CVD 

approach $4 billion annually. The annual cost to taxpayers 

under the Medicaid program for CVD totals more than $240 

million. In addition, health care costs attributed to obesity 

approach $700 million annually, with the highest costs among 

those with type 2 diabetes (a risk factor for cardiovascular 

disease that often coincides with obesity). 

Illinois has created the Illinois Cardiovascular Disease 

Prevention Task Force to reverse these trends. The task 

force will focus on promoting secondary prevention through 

surveillance and the monitoring of blood cholesterol and blood 

pressure levels. It also will encourage education for Illinois 

residents about how to reduce CVD risk factors, with emphasis 

on the importance of maintaining physical activity and proper 

nutrition to reduce obesity rates. 

Text adapted from The Burden of Cardiovascular Disease and Obesity 

in the State of Illinois (June 30, 2000).

Disparities in Health 

The racial and ethnic demographics of Illinois mirror those 

of the United States, with whites representing approximately 

73% of the state’s population, African Americans, 15%, and 

Hispanics, 12%. As with the United States in general, minority 

populations in Illinois have higher prevalence rates of chronic 

diseases, including heart disease, diabetes, and cancer, and of the 

risk factors for these diseases.

Data from CDC’s 2003 Behavioral Risk Factor Surveillance 

System indicate that African Americans in Illinois are more 

likely to report having been told by a doctor that they have 

diabetes (12.0%, compared with 6.6% of Hispanics and 6.2% of 

whites) and Hispanics are more likely to report not meeting the 

recommended guidelines for moderate physical activity (63.4% 

of Hispanics, compared with 59.6% of African Americans and 

55.5% of whites). African Americans and Hispanics are also 

more likely to report being obese than whites (27.1% of African 

Americans and 27.8% of Hispanics, compared with 22.5% of 

whites). All of these risk factors contribute to higher rates of 

death due to heart disease, stroke, and cancer.

In addition, CDC mortality data indicate that African Americans 

in Illinois are more likely to die from cancer than whites or 

Hispanics. In 2000, more African American men died from 

cancer (368.8 per 100,000) than white men (254.7 per 100,000) 

or Hispanic men (155.5 per 100,000). That same year, the rate 

of cancer deaths among African American women (226.1 per 

100,000) was higher than the rate among white women (175.2 

per 100,000) and among Hispanic women (94 per 100,000). 

In February 2004, the governor of Illinois announced the 

creation of new statewide initiatives to begin to address these 

health disparities. The plan proposes $3 million for Health 

Vision for Illinois, which will focus on prevention, promotion, 

protection, and the provision of more effective health care 

services. 

Other Disparities

 Breast Cancer: Even though African American women in 

Illinois are as likely to report having had a mammogram in 

the last 2 years as white women are, they have higher rates of 

death from breast cancer than white women (40.4 per 100,000 

for African American women versus 28.5 for white women).

 Heart Disease: From 1996 to 2000, African Americans in 

Illinois have higher rates of death due to heart disease (709 

per 100,000 for African Americans, compared with 531 per 

100,000 for whites).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Indiana

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Indiana

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Indiana, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Indiana

Estimated Cancer Deaths, 2004 

Cause of death US IN

All Cancers 563,700 13,250

Breast (female) 40,110 890

Colorectal 56,730 1,360

Lung and Bronchus 160,440 4,150

Prostate 29,900 700

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US IN

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US IN

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 13,250 are expected 

in Indiana. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 32,160 

new cases that are likely to be diagnosed in Indiana. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Indiana, accounting for 

15,682 deaths or approximately 28% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 3,877 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Indiana

Indiana’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Indiana BRFSS

 $154,016 

National Program of Cancer Registries 

 Indiana State Cancer Registry

 $988,351 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Indiana Diabetes Prevention and Control Program

 $335,404 

National Breast and Cervical Cancer Early Detection Program 

 Indiana Breast and Cervical Cancer Early Detection Program

 $1,926,397 

National Comprehensive Cancer Control Program 

 Indiana Comprehensive Cancer Control Program

 $125,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Indiana Tobacco Prevention and Control Program

 $1,399,979 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $4,929,147

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Indiana, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Indiana that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Indiana’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African American men (426.7 per 100,000 in 1990 

versus 355.5 per 100,000 in 2000). 

 An 18.8% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 42.3% in 1992 to 23.5% in 2002). 

 A lower prevalence rate than the corresponding national 

rate for self-reported overweight (35.7% in Indiana versus 

36.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Indiana in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Indiana Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD), including heart disease and 

stroke, is the leading cause of death in Indiana. In 2001, the 

state had the 15th highest heart disease death rate and the 15th 

highest stroke death rate in the United States. From 1996 to 

2000, the heart disease death rate for Indiana was 560 per 

100,000, compared with the national heart disease death rate 

of 536 per 100,000. From 1991 to 1998 Indiana’s stroke death 

rate was also higher than the national average (138 per 100,000 

versus 121 per 100,000).

Several major risk factors put individuals at an increased 

risk of developing CVD: smoking, hypertension (high blood 

pressure), high blood cholesterol, overweight and obesity, 

physical inactivity, and diabetes. Indiana has one of the 

nation’s highest percentages of current smokers (26.1% 

compared to the national rate of 22.1%). Indiana also has a 

high hypertension rate (27.0% compared to 24.8% nationally). 

Indiana’s rate for self-reported high blood cholesterol (35.1%) 

is also higher than the national rate (33.1%). 

In 2001, Indiana ranked among the top 10 states for obesity 

prevalence. In 2003, over 61% of adults in Indiana were 

either overweight or obese. Approximately 74.0% of Indiana 

residents reported participating in leisure time physical activity, 

while the national rate was 76.9%. In Indiana, the prevalence 

rate for diabetes was higher than the national average in 2003 

(7.4% compared to 7.1%) and the state’s diabetes death rate in 

2001 (27.7 per 100,000) was higher than the national diabetes 

death rate of 25.2 per 100,000. To address these issues, the 

state developed the Healthy People 2010 goals listed below.

Disparities in Health

Heart disease is the leading cause of death in the United States. 

Among racial and ethnic groups, African American men and 

women have the highest rates of heart disease. In 2001, the 

rate of death for heart disease was 31% higher among African 

Americans than among whites, and 49% higher among men of 

all races than women of all races.

The African American population is the largest racial minority 

group in Indiana, comprising 8.4% of the state’s population. 

African Americans have high rates of the leading risk factors 

for heart disease. The obesity rate among African Americans 

in Indiana (36.6%) is higher than the obesity rate for whites 

(25.6%). African Americans are less likely to particpate in 

lesiure time physical activity (67.2%) than whites (75.1%). In 

addition, African Americans are more likely to report having 

been told that they have high blood pressure (36.8%) than 

whites (27.0%). African Americans also are more likely to 

smoke (31.8%) than whites (25.3%).

Given the disparities in behavioral risk factors described above, 

it is not surprising that the leading cause of death among 

African Americans in Indiana is heart disease. From 1996 to 

2000, the age-adjusted heart disease death rate for African 

Americans was 667 per 100,000, compared with 555 per 

100,000 for whites. From 1991 to 1998, African Americans in 

Indiana also had a higher stroke death rate than whites (162 

per 100,000 versus 136 per 100,000). African Americans also 

had a higher cancer death rate than whites in 2000 (355.5 per 

100,000 for African American men versus 254.7 per 100,000 

for white men, and 202.7 per 100,000 for African American 

women versus 178.1 per 100,000 for white women).

Other Disparities

 Cholesterol: In Indiana, 68.5% of African Americans report 

having had their blood cholesterol checked in the past 5 

years, in comparison with 73.7% of whites.

 Diabetes: In Indiana, 11.5% of African Americans report 

having been told by a doctor that they have diabetes, 

compared with only 7.6% of their white counterparts. The 

diabetes prevalence rate for African Americans in Indiana 

(12%) is also higher than the national rate for African 

Americans (10%). 

 Prostate Cancer: In Indiana, African American men in 

2000 had a prostate cancer death rate that was more than 

twice the rate for white men (71.2 per 100,000 versus 28.5 

per 100,000).

Healthy People 2010 Goals for Indiana: Reducing Cardiovascular 

Disease Risk Factors

Health Indicators Indiana 2001 Indiana 

2010 Target

Increase the proportion of adults 

who are at a healthy weight 38.7% 60.0%

Reduce the prevalence of adults 

who smoke cigarettes regularly 27.6% 12.0%

Reduce the proportion of adults 

who do not engage in leisure time 

physical activity

27.5% 20.0%

Behavioral Risk Factor Surveillance System Indiana Statewide Survey Data, 2002
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Iowa

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Iowa

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Iowa, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Iowa

Estimated Cancer Deaths, 2004 

Cause of death US IA

All Cancers 563,700 6,570

Breast (female) 40,110 430

Colorectal 56,730 710

Lung and Bronchus 160,440 1,680

Prostate 29,900 410

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US IA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US IA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 6,570 are expected in 

Iowa. About 1.4 million new cases of cancer will be diagnosed 

nationally in 2004 alone. This figure includes 15,940 new cases 

that are likely to be diagnosed in Iowa. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Iowa, accounting for 

8,250 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,218 deaths 

or 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Iowa

Iowa’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Iowa BRFSS

 $116,017 

National Program of Cancer Registries $0

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Iowa Diabetes Prevention and Control Program

 $243,170 

National Breast and Cervical Cancer Early Detection Program 

 Iowa Breast and Cervical Cancer Early Detection Program

 $3,052,191 

National Comprehensive Cancer Control Program 

 The Face of Cancer in Iowa

 $401,500 

WISEWOMAN 

 Iowa Care for Yourself 

 $1,094,956 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

Iowa Tobacco Prevention and Control Program

 $669,837 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,577,671 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Iowa, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Iowa that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Iowa’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African American men (422.6 per 100,000 in 1990 

versus 336.8 per 100,000 in 2000).

 A 20.3% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 40.4% in 1992 to 20.1% in 2002). 

 Lower prevalence rates than corresponding national rates 

for self-reported diabetes (6.7% in Iowa versus 7.1% 

nationally) and for self-reported high cholesterol (31.7% in 

Iowa versus 33.1% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Iowa in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Iowa Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD), including heart disease and 

stroke, has been the leading cause of death in Iowa for the past 

10 years, and in 2001 accounted for almost 38% of the state’s 

total deaths. Between 1996 and 2000, the heart disease death 

rate was 493 per 100,000, and the stroke death rate between 

1991 and 1998 was 119 per 100,000. While these death rates 

are lower than the national averages for these diseases (536 

per 100,000 nationally for heart disease and 121 per 100,000 

nationally for stroke), heart disease and stroke are largely 

preventable with behavioral modifications such as improved 

nutrition and physical activity. High blood pressure and 

smoking are also preventable risk factors for cardiovascular 

disease. 

According to 2003 data from CDC’s Behavioral Risk Factor 

Surveillance System (BRFSS), the percentage of adults in 

Iowa who reported participating in physical activities during a 

given month was slightly higher than the national rate (77.3% 

in Iowa versus 76.9% nationally). However, the percentage of 

Iowans who reported consuming 5 or more servings of fruits 

and vegetables per day was slightly lower than the national 

rate (17.1% in Iowa versus 22.5% nationally). In addition, the 

percentage of adults in Iowa who have been told that they have 

high blood pressure was slightly higher than the national rate 

(25.1% in Iowa, compared with 24.8% nationally); however, 

the percentage of smokers in Iowa was slightly lower than the 

national rate (21.7% in Iowa, compared with 22.0% nationally). 

BRFSS data from 2003 indicate that based on body mass 

index, 37.7% of Iowans were overweight and 23.9% were 

obese—rates that are slightly higher than the national rates for 

overweight and obesity (36.7% and 22.8% respectively). 

Iowa has established several programs to address the risk factors 

for CVD. One of these programs is the Iowa Diabetes Network, 

a statewide coalition of health care professionals, voluntary 

organizations, state governmental agencies, insurers, and 

other groups. The Network has established several educational 

opportunities and resources for local use, and works with health 

care providers to promote adherence to national standards of 

care for diabetes. Another program, “Lighten Up Iowa,” is a 

5-month competition that encourages Iowans to develop healthy 

activity and eating habits. This statewide program, which began 

in 2003, has had more than 20,000 participants. 

Disparities in Health

African Americans, who comprise approximately 12% of the 

U.S. population—about 35 million people—experience health 

disparities in significant proportions. African Americans have 

higher stroke mortality rates than other groups as well as a 

higher prevalence of the risk factors for heart disease. Compared 

with other racial and ethnic groups, African Americans are more 

likely to develop lung, cervical, colorectal, and prostate cancer 

at disproportionate levels. 

The African American population in Iowa is about 61,000, 

making up approximately 2% of the state’s population. The 

leading cause of death among African Americans in Iowa (and 

throughout the United States) is heart disease. From 1996 

to 2001, the age-adjusted death rate for heart disease among 

African Americans in Iowa (633 per 100,000) was higher than 

the rate for whites (492 per 100,000). Between 1991 and 1998, 

African Americans in Iowa also experienced a higher stroke 

death rate than their white counterparts (162 per 100,000 versus 

118 per 100,000). 

In 2001, African American men in Iowa had higher incidence 

rates for prostate cancer than white men (198.9 per 100,000 

compared with 148.3 per 100,000) and from 1997 to 2001, they 

had a prostate cancer death rate that was more than double the 

death rate for white men (79.6 per 100,000, compared with 31 

per 100,000).

In Iowa, African Americans also suffer disproportionately from 

diabetes. The age-adjusted death rate for diabetes in 2001 was 

not only higher for Iowa’s African Americans (74.3 per 100,000) 

than for whites (19.5 per 100,000); it was also higher than the 

national diabetes death rate for African Americans (49.1 per 

100,000). The obesity rate for African Americans in Iowa in 

2003 (39.6%) was also higher than the rate for whites (23.8%). 

Consequently, in Iowa the percentage of risk for health problems 

related to being overweight is greater for African Americans 

(67.9%) than for whites (62.0%). 

Other Disparities

 Lung Cancer: In 2000, African American men had a higher 

lung cancer death rate (114.9 per 100,000) than white men 

(76.7 per 100,000).

 Smoking: Hispanics in Iowa are more likely to smoke 

(24.8%) than whites (22.9%). Insufficient data were available 

to compare the rate of smoking for African Americans.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Kansas

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Kansas

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Kansas, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Kansas

Estimated Cancer Deaths, 2004 

Cause of death US KS

All Cancers 563,700 5,330

Breast (female) 40,110 350

Colorectal 56,730 570

Lung and Bronchus 160,440 1,560

Prostate 29,900 350

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US KS

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US KS

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 5,330 are expected 

in Kansas. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 12,940 

new cases that are likely to be diagnosed in Kansas. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Kansas, accounting 

for 6,716 deaths or approximately 27% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 1,848 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Kansas

Kansas’ Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Kansas BRFSS

 $178,807 

National Program of Cancer Registries 

 Kansas Cancer Registry

 $665,122 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $262,691 

Diabetes Control Program 

 Kansas Diabetes Prevention and Control Program 

 $518,016 

National Breast and Cervical Cancer Early Detection Program 

 Free to Know

 $2,176,983 

National Comprehensive Cancer Control Program 

 Bureau of Health Promotion, Cancer Prevention and Control Program

 $150,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Kansas Tobacco Prevention and Control Program

 $1,166,012 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,117,631 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Kansas for FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Kansas that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Kansas’ Prevention

Successes

 Statistically significant decreases in cancer deaths among 

white men (258.9 per 100,000 in 1990 versus 226.5 per 

100,000 in 2000).

 An 18.7% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 37.9% in 1992 to 19.2% in 2002).

 A higher prevalence rate than the corresponding national rate 

for nonsmokers (79.6% in Kansas versus 78.0% nationally) 

and a lower prevalence rate than the corresponding national 

rate for African American women older than age 18 who 

reported not having had a Pap smear in the last 3 years (4.4% 

in Kansas versus 11.0% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Kansas in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Kansas Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Although cardiovascular disease (CVD), including heart 

disease and stroke, is the leading cause of death in Kansas, 

CDC mortality data indicate that from 1996 to 2000 the heart 

disease death rate in Kansas was below the national rate for 

heart disease deaths (481 per 100,000 in Kansas, compared with 

536 per 100,000 nationally). African American women had 

the highest heart disease death rate among women in Kansas 

(516 per 100,000). African American men had the highest heart 

disease death rate among men in Kansas (669 per 100,000), but 

American Indian/Alaska Native (AI/AN) men in the state had a 

higher heart disease death rate than the national rate for AI/AN 

men (588 per 100,000 versus 444 per 100,000). 

In Kansas, the overall death rate for stroke was also slightly 

lower than the national rate (120 per 100,000 in Kansas, 

compared with 121 per 100,000 nationally). Among women, 

African American women had the highest stroke death rate 

in Kansas (174 per 100,000); this rate was higher than the 

national stroke death rate for African American women (153 per 

100,000). Among men, African American men had the highest 

stroke death rate in Kansas (197 per 100,000). As with heart 

disease, the stroke death rate for AI/ANs in Kansas was higher 

than the national rate for AI/AN men (109 per 100,000 versus 

80 per 100,000). 

Risk factors for CVD include poor nutrition and physical 

inactivity, overweight and obesity, smoking, and high blood 

pressure. According to CDC’s Behavioral Risk Factor 

Surveillance System data, Kansas has room for improvement for 

each of these risk factors. Data from 2003 indicate that 81.2% 

of adults in Kansas did not consume 5 or more servings of 

fruits and vegetables per day (compared with 77.5% nationally) 

and 56.3% of adults in Kansas did not meet the recommended 

guidelines for moderate physical activity (compared with 52.8% 

of adults nationally). Because of these behaviors, more than 

60.0% of adults in Kansas were overweight (37.4%) or obese 

(22.8%). In addition, almost one quarter of adults in Kansas 

reported having been diagnosed with high blood pressure 

(23.3%) and one fifth of adults in Kansas (20.4%) reported that 

they smoked.

Kansas has recently received a Heart Disease and Stroke 

Prevention Grant from CDC to address the disease’s major 

risk factors as well as to improve prevention, treatment, and 

emergency response to heart attack and stroke.

Disparities in Health

Almost 20% of the U.S. population lives in rural areas. People 

in these areas have a higher risk of heart disease, diabetes, 

and cancer, which is attributable in part to a population that 

is older, sicker, poorer, and less educated. However, there are 

rural and urban disparities in health care that are associated 

with infrastructure or professional capacity to address such 

health needs, which include disparities in access to health care 

professionals and health care services. 

There are 105 counties in Kansas. Of this number, 38 counties 

are designated as rural (6.0 to 19.9 residents per square mile) 

and 31 are designated as frontier (<6.0 residents per square 

mile). These counties tend to have lower incomes and less 

education than statewide averages. In 2000, the median 

family income in 67 of these 69 frontier and rural counties 

was below the state average for family income. In addition, 

twelve frontier and rural counties have elderly populations of 

25% or greater. The state’s geography has a direct influence 

on transportation, health care workforce availability, and other 

areas of health service delivery. 

In addition to rural and urban disparities, Kansas is also 

faced with disparities in its minority populations. The 

state’s population is approximately 69% white, 12% African 

American, and 13% Hispanic. The remaining 5% includes 

Asian/Pacific Islanders and American Indians/Alaska Natives. 

Kansas, like other states, faces challenges in measuring 

the extent of existing racial and ethnic disparities due to 

limitations in data collection tools, however some racial and 

ethnic health disparities are reported below. 

Other Disparities

 Cancer: A 2003 report on a survey conducted by the Kansas Health Institute cited disparities in cancer rates among 

the state’s racial and ethnic groups. African American men, 

in comparison to the state’s general population, had the 

highest rates for certain types of cancers. The survey also 

found that lung cancer is especially high among the AI/AN 

population.

 Diabetes: In Kansas, 8% of African Americans and 8% of 

AI/ANs reported that they had diabetes, compared to 5% 

of the general population.

 Obesity: African Americans in Kansas are more likely to 

be obese (34.9%) than their white counterparts (22.3%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Kentucky

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Kentucky

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Kentucky, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Kentucky

Estimated Cancer Deaths, 2004 

Cause of death US KY

All Cancers 563,700 9,360

Breast (female) 40,110 620

Colorectal 56,730 890

Lung and Bronchus 160,440 3,380

Prostate 29,900 340

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US KY

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US KY

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 9,360 are expected 

in Kentucky. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 22,720 

new cases that are likely to be diagnosed in Kentucky. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Kentucky, accounting 

for 11,808 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,557 deaths 

or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Kentucky

Kentucky’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Kentucky BRFSS

 $182,296 

National Program of Cancer Registries 

 Kentucky Cancer Registry

 $619,972 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Get With the Guidelines

 $415,000 

Diabetes Control Program 

Kentucky Diabetes Prevention and Control Program

 $639,820 

National Breast and Cervical Cancer Early Detection Program

Kentucky Women’s Cancer Screening Project

 $2,516,239 

National Comprehensive Cancer Control Program 

University of Kentucky Markey Cancer Control Program

 $299,859 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Kentucky Tobacco Prevention and Control Program

 $994,147 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Gentle Fitness

 Nutrition & Physical Activity Program

 $413,847 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $6,081,180

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Kentucky, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Kentucky that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Kentucky’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African American men (441.6 per 100,000 in 1990 

versus 378.4 per 100,000 in 2000). 

 A 27.9% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 49.3% in 1992 to 21.4% in 2002).

 A prevalence rate that was lower than the corresponding 

national rate for African American women older than age 

18 who reported not having had a Pap smear in the last 3 

years (4.7% in Kentucky versus 11% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Kentucky in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Kentucky Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Cardiovascular Disease

In Kentucky, cardiovascular disease (CVD) is the leading 

cause of death in every county. Seventy-three of Kentucky’s 

120 counties have CVD mortality rates above the national 

average, and 20 counties that exceed the national average 

by 25%. In 2000, the American Heart Association ranked 

Kentucky 48th in the nation for its age-adjusted CVD death 

rate. Nationwide death rates from CVD have declined 

significantly in the past 2 decades. From 1980 to 1985, 

Kentucky’s CVD death rates declined by 2.2% per year, and 

from 1985 to 1990, they declined by 2.5% per year. However, 

from 1995 to 1997, this decline had slowed—during that 

period, the state’s CVD deaths dropped by only 1.5% per year. 

One of the most common and damaging myths about CVD is 

that it is primarily a “man’s disease.” In 2001, 6,085 women 

in Kentucky died from CVD compared with 5,723 men. 

Statewide, women comprise 53% of all CVD deaths. The risk 

of heart disease and stroke for women increases steadily with 

age, particularly after menopause, when protective estrogen 

levels are diminished. 

Kentucky is using the Healthy People 2010 program as an 

opportunity to reverse these trends in CVD death rates. The 

state has set relevant Healthy People 2010 objectives such as 

reducing CVD deaths to no more than 200 deaths per 100,000 

people. Kentucky also aims to reduce the prevalence of CVD 

risk factors and to increase awareness about CVD and its high 

death rate for women. 

Text adapted from Kentucky State of the Heart (2000).

Disparities in Health

Cardiovascular disease, which includes heart disease and stroke, 

is the leading cause of death among women in the United 

States and in Kentucky. In 1999, CVD accounted for 32.4% 

of all female deaths in Kentucky; in that same year, women 

represented 53.6% of all CVD deaths in Kentucky. In Kentucky, 

women who die from CVD tend to be older than men who die 

from CVD; 44.6% of female CVD deaths were among women 

age 85 and older, versus only 21.2% of men age 85 and older. 

Women who have heart attacks are more than twice as likely as 

men to die from them within the first year of the heart attack. 

In addition, in Kentucky, when compared with white women, 

African American women have a higher death rate for heart 

disease (606 per 100,000 for African American women versus 

496 per 100,000 for white women) and for stroke (158 per 

100,000 for African American women versus 127 per 100,000 

for white women). 

In Kentucky, the rates of women who died from heart disease 

(501 per 100,000) and stroke (128 per 100,000) are higher than 

the national rates for both diseases (438 per 100,000 for heart 

disease and 117 per 100,000 for stroke). Although both rates 

are declining, in 2000, Kentucky ranked as the 6th highest state 

in the nation for age-adjusted heart disease death rates among 

women.

Other Disparities

 Diabetes: African Americans are more likely than any other 

group in Kentucky to report that they have been told by a 

doctor that they have diabetes (14.2% for African Americans, 

compared with 8.3% for whites and 5.0% for Hispanics).

 Overweight and Obesity: In Kentucky, 67.1% of African 

Americans are either overweight or obese (34.1% are overweight and 33% are obese), compared with 63.1% of their 

white counterparts (37% are overweight and 25.6% are 

obese). 

 Prostate Cancer: Rates of death from prostate cancer are 

higher for African American men than for white men (54.5 

per 100,000 versus 31.8 per 100,000).

 Cervical Cancer: In 2002, African American women were 

more likely than white women to have had a Pap smear in the 

last 3 years (97.2% versus 89.1%); however, CDC mortality 

data from 1997 to 2001 indicate that African American 

women had a higher cervical cancer death rate than white 

women (6.3 per 100,000 versus 3.4 per 100,000).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Nephritis 2%

Heart Disease 

29.6%

Cancer 

23.5%

All others

18.3%

Diabetes 2.8%

Alzheimer’s

Disease 2.4%

Chronic Lower 

Respiratory Disease 5.7% 

Septicemia

1.5%

Stroke 6.4%

Influenza

2.8%

Major Causes of Death in Kentucky, 2001

Source: 2001 CDC Mortality Data

Unintentional

Injury 5%
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Louisiana

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Louisiana

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Louisiana, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Louisiana

Estimated Cancer Deaths, 2004 

Cause of death US LA

All cancers 563,700 9,700

Breast (female) 40,110 730

Colorectal 56,730 990

Lung and Bronchus 160,440 2,920

Prostate 29,900 480

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US LA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US LA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 9,700 are expected 

in Louisiana. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 23,540 

new cases that are likely to be diagnosed in Louisiana.

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Louisiana, accounting 

for 11,474 deaths or approximately 27% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,638 deaths 

or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Louisiana

Louisiana’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

Louisiana BRFSS

 $155,763 

National Program of Cancer Registries 

 Louisiana Tumor Registry

 $620,070 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Louisiana Stroke Education Consortium

 Delta States Stroke Consortium

 Heart Disease and Stroke Coalition

 Healthy Communities

 National Black Women’s Health Project

 $279,550 

Diabetes Control Program 

 Louisiana Statewide Diabetes Advisory Council

 Defeat Diabetes Through Education Project

 $107,000 

National Breast and Cervical Cancer Early Detection Program 

 Louisiana Breast and Cervical Health Program

 $1,076,140 

National Comprehensive Cancer Control Program

 Louisiana Cancer and Lung Trust Fund Board

 Louisiana Cancer Control Strategic Plan

 $150,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Louisiana Tobacco Prevention and Control Program

 $1,106,410 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $3,494,933

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Louisiana, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Louisiana that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Louisiana’s Prevention

Successes

 Statistically significant decreases in cancer deaths for men 

across all races (329.6 per 100,000 in 1990 versus 296.6 per 

100,000 in 2000). 

 A 19.8% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 39.9% in 1992 to 20.1% in 2002).

 A prevalence rate that was lower than the corresponding 

national rate for women older than age 18 who reported 

not having had a Pap smear in the last 3 years (15.1% in 

Louisiana versus 16.7% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Louisiana in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Louisiana Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD) is a serious public health concern 

in Louisiana. In 2001, CDC mortality data indicated that 

Louisiana had the nation’s 8th highest heart disease death rate 

and the 12th highest stroke death rate. Although heart disease is 

the leading cause of death in Louisiana for both men and women 

ages 65 and over, it does not only affect the elderly—it is also 

the second leading cause of premature death in adults between 

the ages of 45 and 64. In addition, heart disease is the second 

leading cause of death among women ages 35 to 44. 

Gender, more than race, is a predictor of heart disease in 

Louisiana. In 2000, the age-adjusted death rate for heart disease 

was 40% higher for men than for women (241.2 per 100,000 

versus 141.7 per 100,000). During that same period, however, 

death rates from stroke were much higher for both African 

American men and women (84.6 per 100,000 and 78.1 per 

100,000, respectively) than for white men and women (55.9

per 100,000 and 55.1 per 100,000, respectively).

CVD also poses a significant economic burden on the state. In 

1999, more than 76,000 hospitalizations (approximately 14.2% 

of all hospitalizations) in Louisiana were attributed to CVD. 

That same year, CVD accounted for more than $1.4 billion 

dollars in hospital costs. The average hospitalization for CVD 

lasted 5 days and cost $17,368.

The Louisiana Cardiovascular Health Program has identified the 

following strategies to address the problem of CVD in the state:

 Develop and coordinate partnerships with professional associations, medical schools and universities, the Governor’s 

Council on Physical Fitness and Sports, the Cooperative 

Extension Program, the Primary Care Association, and the 

State Department of Education.

 Develop scientific capacity to define the CVD problem by 

developing and maintaining a surveillance system, and identifying and accessing existing sources of cardiovascular data.

 Develop an inventory of policy and environmental strategies.

 Develop a state plan of action.

 Provide training and technical assistance for program staff.

 Develop population-based prevention intervention strategies.

 Develop culturally competent strategies for priority 

populations.

Text adapted from 2002 Louisiana State of the Heart and Stroke Report.

Disparities in Health

African Americans, Louisiana’s largest minority group, make 

up 32% of the state’s population, more than twice the national 

percentage. Individual parishes in Louisiana range from 5% 

to 67% African American. The leading causes of death for 

African Americans in Louisiana are cardiovascular disease 

—including heart disease and stroke—and cancer.

Between 1996 and 2000, African Americans in Louisiana 

had a higher heart disease death rate (669 per 100,000) than 

whites (577 per 100,000), Asian/Pacific Islanders (252 per 

100,000), American Indian/Alaska Natives (AI/ANs; 240 per 

100,000) and Hispanics (224 per 100,000). Between 1991 

and 1998, African Americans also had a higher stroke death 

rate than any other group (172 per 100,000, compared with 

121 per 100,000 for whites, 88 per 100,000 for Asian/Pacific 

Islanders, 79 per 100,000 for AI/ANs, and 55 per 100,000 for 

Hispanics).

African Americans also experience a disproportionate number 

of cancer deaths. In 2000, African American men had a 

cancer death rate of 383.3 per 100,000, compared with 272 

per 100,000 for white men. African American women also 

had a higher cancer death rate than white women (209.0 

per 100,000, compared with 175.4 per 100,000). For some 

types of cancer, the disparities are even more noticeable. For 

example, African American men have a prostate cancer death 

rate that is more than twice the rate for white men (61.6 per 

100,000, compared with 25.1 per 100,000).

Data indicate that lifestyle factors within the African 

American community contribute to the risk factors associated 

with chronic disease. Such factors include the following:

 High Blood Pressure: More African Americans reported 

having high blood pressure than other racial and ethnic 

groups in the state (34.1%, compared with 27.5% of 

whites and 20.5% of Hispanics). 

 Inactivity and Obesity: More than a third of African 

Americans (36.6%) reported having a sedentary lifestyle—

no exercise in a 1-month period—compared with 27.5% 

of whites and 30.2% of Hispanics. In addition, 35.1% 

of African Americans reported that they were obese, 

compared with 21.6% of whites.

 Diabetes: More African Americans reported that they 

had been diagnosed with diabetes (11.9%) than Hispanics 

(7.1%) or whites (7.2%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Maine

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Maine

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Maine, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Maine

Estimated Cancer Deaths, 2004 

Cause of death US ME

All Cancers 563,700 3,100

Breast (female) 40,110 170

Colorectal 56,730 310

Lung and Bronchus 160,440 880

Prostate 29,900 150

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US ME

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US ME

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 3,100 are expected in 

Maine. About 1.4 million new cases of cancer will be diagnosed 

nationally in 2004 alone. This figure includes 7,500 new cases 

that are likely to be diagnosed in Maine. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Maine, accounting for 

3,272 deaths or approximately 26% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 822 deaths or 

approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Maine

Maine’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Maine BFRSS

 $201,296 

National Program of Cancer Registries

 Maine Cancer Registry

 $393,612 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Heart Healthy and Stroke-Free in Maine

 $1,155,913 

Diabetes Control Program

 Ambulatory Diabetes Education and Follow-up Program

 Maine Consortium for Clinical Office System Improvement (COSI)

 Maine Diabetes Cooperative

 Quality Assurance/Professional Education

 $360,000 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Health Program

 $1,527,658 

National Comprehensive Cancer Control Program 

 Maine Cancer Consortium

 The Maine Comprehensive Cancer Control Plan 2001-2005

 $245,406 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Maine Tobacco Prevention and Control Program

 $784,598 

State Nutrition and Physical Activity/Obesity Prevention Program 

 All Children Exercising Simultaneously (ACES) $450,000 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,118,483

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Maine, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Maine that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Maine’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

white men (301.4 per 100,000 in 1990 versus 259.3 per 

100,000 in 2000).

 A 17.5% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 32.8% in 1992 to 15.3% in 2002).

 A prevalence rate that is higher than the corresponding 

national rate for individuals who reported that they were 

neither overweight nor obese (41.8% in Maine versus 40% 

nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Maine in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Maine Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Disparities in Health

In 2000, the number of Hispanics living in Maine was 9,360, or 

0.7% of the state’s population, an increase of 37% from 1990. 

Since 97% of the state’s population is white, data on health 

disparities are limited; however, the state is working to clarify 

health data for the Hispanic population. 

A 2002 state Bureau of Health review of health data for the 

Hispanic population poses some inconsistencies regarding 

the health disparities that affect Maine’s Hispanics. While 

clinic data from the Maine Migrant Health Program clearly 

indicate that Hispanic seasonal and migrant farmworkers are at 

a socioeconomic and health disadvantage, an analysis of data 

that is primarily focused on nonmigrant Hispanic populations 

in Maine paints a different picture. For instance, data from the 

U.S. Census, the Behavioral Risk Factor Surveillance System 

(BRFSS), the Bureau of Vital Statistics, and the Pregnancy 

Risk Assessment Monitoring System (PRAMS) suggest higher 

rates of health risk factors (physical inactivity, obesity, and 

hypertension) among Maine’s Hispanics, but mortality data 

suggest that the state’s Hispanics have lower age-adjusted 

death rates from chronic disease than whites and other racial 

and ethnic groups. Likewise, some data suggest that Hispanics 

in Maine have poor health status (shorter life expectancy and 

higher rates of domestic violence during pregnancy), while other 

data suggest the opposite (low infant mortality rates and higher 

rates of mammogram screening). 

Socioeconomic data also suggest some inconsistencies. Census 

data regarding per capita income and education attainment, and 

data from PRAMS that identify childcare, transportation, and 

lack of insurance as barriers to health care services for Hispanics 

suggest that this population is at a socioeconomic disadvantage. 

However, low unemployment levels and BRFSS data on income 

levels and health insurance for this population suggest that the 

socioeconomic status of Maine’s Hispanics is similar to that of 

other Maine residents.

These inconsistencies may be due to multiple factors, including:

 Possible undercounting by the Census and by other surveys;

 Possible inaccuracies and misclassifications in the collection 

of ethnicity data in health data sets;

 Statistical analyses problems, such as variant outcomes 

encountered when working with small sample sizes; and

 Cultural and socioeconomic diversity within Maine’s 

Hispanic population.

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD) is a serious public health 

concern in Maine. Although heart disease is the leading cause 

of death for both men and women age 65 and over, heart 

disease does not only affect the elderly—it is also the second 

leading cause of premature death in adults between the ages 

of 45 and 64. Although it is assumed that heart disease is 

a condition that primarily affects men, in 2001, 51.8% of 

Maine’s total heart disease deaths were among women.

CVD is also a significant economic burden on the state. 

In 2000, there were over 29,000 hospitalizations in Maine 

attributed to CVD. The cost of CVD—which accounts for 25% 

of all Maine hospital costs—totaled $437 million in 2000. 

In addition, Medicare or Medicaid payments cover 72% of 

Maine’s CVD-related hospital charges. 

To address these problems, the Maine Cardiovascular 

Health Program is working with a network of community, 

government, and health partners to explore prevention 

opportunities in neighborhood, school, work site, and health 

care settings. Together, these organizations are conducting 

programs, changing policies, and changing the environment 

to support children and adults in maintaining a tobacco-free 

lifestyle, eating healthy foods, being physically active, and 

maintaining a healthy weight. The Program and its network are 

working to ensure that health care organizations provide heart 

disease risk factor screening and treatment, that health care 

professionals are able to identify and treat heart disease, and 

that the unique needs of disparate populations are addressed. 

The components of the Maine Cardiovascular Health Program 

include:

 Assisting the 31 Healthy Maine Community Partnerships 

and other community groups to address physical inactivity, 

poor nutrition, tobacco use, high blood pressure, and high 

cholesterol. 

 Assisting businesses in implementing low- or no-cost 

strategies to improve employee health. 

 Developing and conducting a statewide media and public 

awareness campaign on physical activity and nutrition. 

 Developing state-level policies that support individuals 

making healthy choices. 

Data are from the Maine Cardiovascular Health Program Fact Sheet.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Maryland

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Maryland

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Maryland, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Maryland

Estimated Cancer Deaths, 2004 

Cause of death US MD

All Cancers 563,700 10,430

Breast (female) 40,110 760

Colorectal 56,730 1,090

Lung and Bronchus 160,440 2,940

Prostate 29,900 530

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MD

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MD

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 10,430 are expected 

in Maryland. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 25,310 

new cases that are likely to be diagnosed in Maryland. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Maryland, accounting 

for 12,310 deaths or approximately 28% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,882 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Maryland

Maryland’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Maryland BRFSS

 $149,566 

National Program of Cancer Registries 

 Maryland Cancer Registry

 $186,503 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0 

Diabetes Control Program 

 Maryland Diabetes Prevention and Control Coalition

 Maryland Diabetes Awareness Partnership Network

 $291,386 

National Breast and Cervical Cancer Early Detection Program 

 Center for Cancer Surveillance and Control

 $3,929,848 

National Comprehensive Cancer Control Program 

 Maryland State Council on Cancer Control

 Maryland Comprehensive Cancer Control Plan 2004-2008

 $388,705 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Maryland Tobacco Prevention and Control Program

 $1,025,555 

State Nutrition and Physical Activity/Obesity Prevention Program 

 GET ACTIVE. GET HEALTHY!

 Legislative Fitness Day

 Maryland High School Dance Showcase

 Maryland Senior Olympics

 Project Superfit

 Seniors Celebrate for Health and Fitness

 Physical Activity Speakers Bureau

 Walk in Maryland

 Maryland is for Movers Conference

 $398,964 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $6,370,527

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Maryland, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Maryland that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Maryland’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African American men (449.9 per 100,000 in 1990 

versus 335.4 per 100,000 in 2000).

 A 10.8% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 27.1% in 1992 to 16.3% in 2002). 

 Lower prevalence rates than the corresponding national rates 

for self-reported current smokers (20.1% in Maryland versus 

22.0% nationally) and for self-reported obesity (21.9% in 

Maryland versus 22.8% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Maryland in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Maryland Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

In 2001, cardiovascular disease (CVD), including heart disease 

and stroke, was the primary cause of death for all Marylanders. 

Many believe that CVD is a man’s disease, but a greater number 

of women die from CVD than men. CDC heart disease mortality data from 1996 to 2000 indicate that the heart disease death 

rate for women in Maryland was 430 per 100,000. Although this 

was lower than national rate for women, 438 per 100,000, the 

data also show that in 2001, heart disease was the leading cause 

of death for women age 65 and over and was the second leading 

cause of death for women age 35 to 44, 45 to 54, and 55 to 64.

Tobacco use, physical inactivity, poor nutrition, obesity, hypertension, high blood cholesterol, and diabetes are known and 

modifiable risk factors for CVD. According to 2003 data from 

CDC’s Behavioral Risk Factor Surveillance System (BRFSS), 

the overall rate of adult smokers in Maryland was 20.1%. In 

addition, about one fifth of Maryland’s adult population was estimated to be physically inactive, 71.1% were consuming fewer 

than 5 servings of fruits and vegetables a day, 21.9% were obese, 

and 7.0% reported that they had been told they have diabetes. 

Twenty five percent of the state’s adult population had high 

blood pressure and 33.9% had high blood cholesterol. African 

Americans, those in lower-income populations, and those with 

lower levels of education tended to have higher rates of smoking, 

physical inactivity, high blood pressure, obesity, and diabetes. 

In Maryland, there were 448,729 days of hospitalization in 

1999 attributed to CVD. Hospital charges alone for these 

hospital stays were more than $890 million. Of this amount, 

$140 million represents the charges for stroke hospitalizations.

In order to address the issue of CVD in Maryland, the state has 

developed several CVD prevention initiatives. The Office of 

Chronic Disease Prevention, through its Diabetes Control 

Program, and the Division of Cardiovascular Health and 

Nutrition provide grants and technical assistance to local 

jurisdictions in the state for community-level outreach and 

education. Other CVD prevention efforts include partnering with 

state agencies throughout the state, such as the Governor’s 

Office on Smart Growth, the Department of Natural Resources 

and the Department of Transportation. The state also obtained a 

grant to implement the Smart Step Forward coalition to revise 

local codes and to make other changes aimed at encouraging 

walking in three Maryland communities. 

Text adapted from Preventing Cardiovascular Disease in Maryland: 

Public Health Strategies, (2003).

Disparities in Health

African Americans comprise approximately 12% of the U.S. 

population and tend to have higher rates of behavioral risk 

factors for chronic diseases as well as higher heart disease, 

stroke, and cancer mortality rates.

African Americans, who make up approximately 27.9% of 

Maryland’s population, experience high rates of risk factors 

for heart disease and cancer—and high heart disease and 

cancer death rates. Data from CDC’s Behavioral Risk Factor 

Survaillance System for 2003 indicate that African Americans 

are less likely than whites to consume 5 or more servings of 

fruits and vegetables per day (27.5% versus 28.6%) and are 

less likely to participate in leisure time physical activity than 

whites (72.6% versus 82.7%). African Americans are also more 

likely to be obese than whites (30.5% versus 19.7%), more 

likely to have high blood pressure than whites (28.3% versus 

26.0%), and more likely to report having been told that they 

have diabetes than whites (9.9% versus 6.6%).

Given the prevalence rates of the above risk factors for heart 

disease and stroke, it is not surprising that African Americans 

also have higher heart disease and stroke death rates than 

whites. From 1996 to 2000, African Americans in Maryland 

had a heart disease death rate of 620 per 100,000, compared 

with 500 per 100,000 for whites. From 1991 to 1998, African 

Americans in Maryland had a stroke death rate of 145 per 

100,000, compared with 110 per 100,000 for whites.

Other Disparities

 Breast Cancer: In 2002, BRFSS data indicate that 

African American women had higher rates of breast cancer 

screening in the last 2 years (85.1%) than whites (83.3%); 

however, in 2000, they had a higher breast cancer death 

rate than whites (34.1 per 100,000, compared with 26.0 per 

100,000).

 Cervical Cancer: Like breast cancer, 2002 BRFSS data 

indicate that African American women were more likely to 

report having had a Pap smear in the last 3 years (90.7%) 

than white women (89.2%), but from 1997 to 2001, African 

American women in Maryland had a higher cervical cancer 

death rate than white women (4.6 per 100,000, compared 

with 2.3 per 100,000).

 Prostate Cancer: African American men in Maryland in 

2000 had a prostate cancer death rate that was more than 

twice as high as the rate for white men (62.7 per 100,000, 

compared with 27.1 per 100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Massachusetts

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Massachusetts

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Massachusetts, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Massachusetts

Estimated Cancer Deaths, 2004 

Cause of death US MA

All Cancers 563,700 13,620

Breast (female) 40,110 960

Colorectal 56,730 1,360

Lung and Bronchus 160,440 3,740

Prostate 29,900 740

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 13,620 are expected 

in Massachusetts. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 33,050 

new cases that are likely to be diagnosed in Massachusetts. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart

disease is the leading cause of death in Massachusetts, accounting for 15,144 deaths or approximately 27% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 3,535 

deaths or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Massachusetts

Massachusetts’ Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

Massachusetts BRFSS

 $232,759 

National Program of Cancer Registries 

 Massachusetts Cancer Registry

 $1,333,485 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Massachusetts Coalition for Cardiovascular Health 

 Stroke Task Force

 $360,000 

Diabetes Control Program 

 Diabetes y Usted Program

 Diabetes Today Coalition

 $859,266 

National Breast and Cervical Cancer Early Detection Program

 Women’s Health Unit

 $3,687,766 

National Comprehensive Cancer Control Program 

 Cancer Prevention and Control Initiative

 Massachusetts Comprehensive Cancer Control Plan 

 $717,181 

WISEWOMAN 

 Massachusetts Department of Public Health

 $1,250,354 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Massachusetts Tobacco Control Program

 $1,717,484 

State Nutrition and Physical Activity/Obesity Prevention Program $1,000,000 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Boston Public Health Commission

 Boston Public Health Commission (AOA)

 Center for Community Health Education & Research, Inc.

 Greater Lawrence Family Health Center, Inc.

 Lowell Community Health Center

 $984,692 

 $249,959 

 $905,000 

 $905,360 

 $905,000 

Total $15,108,306 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Massachusetts, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Massachusetts that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Massachusetts’ Prevention

Successes

 A decrease in the rate of heart disease, stroke, and all 

cancers for all races occurred between 1995 and 2001. 

Rates for heart disease and stroke in 2001 were lower than 

the national average. 

 A 17.3% decrease in the number of women older than age 

50 who reported not having had a mammogram (from 

31.8% in 1992 to 14.5% in 2002).

 A prevalence rate that was lower than the corresponding 

national rate for self-reported obesity (16.8% in 

Massachusetts versus 22.8% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding needed to implement effective chronic disease prevention programs 

and ensure that all Americans have access to quality health care. 

CDC funding and support enable state health departments to 

respond efficiently to changing health priorities and effectively 

use limited resources to meet a wide range of health needs 

among specific populations. The table below is a breakdown 

of the CDC’s funding awards to Massachusetts in the areas of 

cancer, heart disease, stroke, and related risk factors. 
4

Massachusetts Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: 

Overweight and Obesity

One of every two Massachusetts adults is either overweight or 

obese. Although Massachusetts has the 4th lowest percentage 

of overweight adults in the United States, the percentage of 

adults who are overweight or obese increased from 40.1% in 

1990 to 53.0% in 2003. According to CDC’s 2003 Behavioral 

Risk Factor Surveillance System data, the percentage of 

overweight or obese men in the state was higher than the 

percentage for overweight women (63.1% for men versus 

43.2% for women). The percentage of obese adults also 

increases with age until age 64, then decreases. 

Several factors cause obesity and overweight: food and 

nutrient consumption patterns, a lack of physical activity, and 

socioeconomic factors. According to 2003 data from the 

BRFSS, adults with less than a high school education had an 

obesity rate that was 2 times greater (26.9%) than the obesity 

rate for adults with a college degree (12.1%). Findings were 

similar among Massachusetts residents with different income 

levels; 22.1% of adults with annual incomes of $25,000 or less 

were obese, while only 14.2% of adults with annual incomes 

of $50,000 or greater were obese. 

Overweight and obesity are also problems for infants and 

children in Massachusetts. More than one third of children 

ages 2 to 5 are either at risk of being overweight or are already 

overweight. The prevalence rate of risk for overweight among 

children ages 2 and older in Massachusetts is 33%, compared 

with the national prevalence rate of 28%. The prevalence of 

risk for overweight is highest among Hispanic children; it is 

lowest among Asian/Pacific Islander children. 

Overweight and obesity are also risk factors for diabetes. The 

prevalence rate of diabetes in Massachusetts in 2003 was 

lower than the national rate (6.2% versus 7.1%); however, the 

diabetes death rate in Massachusetts in 2001 was higher than 

the national rate (25.7 per 100,000, compared with 25.2 per 

100,000). 

As part of the Healthy People 2010 Initiative, Massachusetts 

has established objectives for reducing the prevalence of 

overweight and obesity. These objectives include reducing the 

proportion of children and adolescents who are overweight 

(from 10% to 5%), and reducing the proportion of adults who 

are obese (from 17% to 15%). 

Text adapted from Healthy People 2010—

Leading Health Indicators for Massachusetts.

Disparities in Health

African Americans and Hispanics comprise approximately 25% 

of the U.S. population. In Massachusetts, Hispanics make up 

approximately 7% of the state’s population; African Americans 

make up approximately 5%. African Americans and Hispanics 

in the United States experience disproportionate socioeconomic 

hardships and health disparities. African Americans have higher 

stroke death rates than other population groups and a higher 

prevalence of the risk factors for heart disease. Hispanics, who 

are almost twice as likely to die from diabetes as non-Hispanic 

whites, also have higher rates of high blood pressure and 

obesity than their white counterparts. 

In Massachusetts, the leading cause of death is heart disease. 

The state’s African Americans and Hispanics are at the greatest 

risk for health problems related to overweight and obesity, 

which are risk factors for heart disease. Data from CDC’s 

2003 Behavioral Risk Factor Surveillance System indicate that 

rates of obesity in Massachusetts are highest among African 

Americans and Hispanics (27.6% and 22.0%, respectively). Of 

all racial and ethnic groups, Hispanics are the least likely to 

participate in regular physical activity (42.3%, in comparison 

with the 28.3% of African Americans and 19.1% of whites). 

As mentioned previously, several socioeconomic factors such 

as household income and education appear to be directly 

related to obesity and overweight. In Massachusetts, Hispanics 

and African Americans have the state’s lowest per capita 

incomes; in 2003, more than 50% of Hispanics and 40% of 

African Americans had an annual income of less than $25,000. 

The Hispanic population in Massachusetts has the highest 

percentage of adults with less than a high school education 

(37.7%), in comparison with African Americans (14.8%) and 

whites (5.6%). 

Other Disparities

 Diabetes: In Massachusetts, the percentage of Hispanic 

adults who report being told by a doctor that they have 

diabetes is 8.7%, (a rate higher than that of any other racial 

or ethnic group), followed by African American adults 

(7.1%) and whites (6.0%). However, these rates decrease 

with increasing education and annual income. 

 Cholesterol Screening: Whites in Massachusetts are the 

most likely to have had their blood cholesterol checked 

(83.5%), followed by African Americans (75.5%); 

Hispanics are the least likely to have had their blood 

cholesterol checked (69.3%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Michigan

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Michigan

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Michigan, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Michigan

Estimated Cancer Deaths, 2004 

Cause of death US MI

All Cancers 563,700 19,870

Breast (female) 40,110 1,350

Colorectal 56,730 1,900

Lung and Bronchus 160,440 5,690

Prostate 29,900 1,110

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MI

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MI

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 19,870 are expected 

in Michigan. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 48,220 

new cases that are likely to be diagnosed in Michigan. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Michigan, accounting 

for 26,896 deaths or approximately 31% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 5,701 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Michigan

Michigan’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Michigan BRFSS

 $225,000 

National Program of Cancer Registries 

 Michigan Department of Community Health

 $500,529 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0 

Diabetes Control Program 

 Upper Peninsula Diabetes Outreach Network

 Certified Diabetes Outpatient Education Program

 Local Health Department Diabetes Project

 $864,960 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Control Program

 $8,273,828 

National Comprehensive Cancer Control Program 

 Michigan Cancer Consortium Initiative

 Michigan Plan for Action

 $1,229,173 

WISEWOMAN 

Michigan Department of Community Health

 $750,000 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Michigan Tobacco Prevention and Control Program

 $1,700,000 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Community Health and Social Services Center

 Genesee County Health Department 

 Migrant Health Promotion, Inc.

 $911,467

 $930,391

 $904,900 

Total $16,290,248

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Michigan, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Michigan that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Michigan’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

among African American men (373.7 per 100,000 in 1990 

versus 314.3 per 100,000 in 2000). 

 An 11.7% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 30.4% in 1992 to 18.7% in 2002). 

 A lower prevalence rate than the corresponding national rate 

for women older than age 18 who reported not having had 

a Pap smear in the last 3 years (14.6% in Michigan versus 

16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Michigan in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Michigan Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Disparities in Health

According to the 2000 Census, Michigan had the 8th largest 

population in the United States, with over three quarters of 

its residents living in metropolitan areas. The state’s minority 

populations are increasing in proportion to the population as 

a whole. Cardiovascular disease (CVD) has been the number 

one cause of death in Michigan since the early 1900’s; 4 out 

of every 10 deaths in Michigan is attributed to CVD. From 

1996 to 2000, the heart disease death rate among Michigan’s 

African Americans, who comprise about 13% of the state’s 

population, was 709 per 100,000, compared with the national 

rate for African Americans of 662 per 100,000. The heart 

disease death rate among Michigan’s African Americans is 

also higher than the rate among whites in the state (709 per 

100,000 versus 561 per 100,000). 

According to 2003 data from CDC’s Behavioral Risk Factor 

Surveillance System, the rate of obesity among African 

Americans in Michigan (34.8%) was higher than the rate 

among whites (23.7%). Approximately 66.0% of African 

Americans in Michigan were at risk for health problems 

related to being overweight, putting them more at risk than 

either whites (61.4%) or Hispanics (60.4%). Although 72.2% 

of African Americans in Michigan report participating in 

physical activity, the percentage is lower than that of their 

white counterparts (79.4%). In addition, African Americans 

were less likely to report consuming 5 or more servings of 

fruits and vegetables per day than whites (16.3%, compared 

with 20.0%).

The increase in diabetes prevalence in Michigan has been 

higher than the increase in other states. Approximately 11% 

of African Americans in Michigan report that they have been 

diagnosed with diabetes, compared with approximately 7% 

of whites. The diabetes death rate for African Americans in 

Michigan is significantly higher than the rate for whites (40.8 

per 100,000 versus 25.2 per 100,000).

Other Disparities

 Smoking: In Michigan, 29.6% of African Americans were 

smokers in 2003, compared with 25.5% of whites. 

 Stroke: Between 1991 and 1998 in Michigan, the stroke 

death rate among African Americans (151 per 100,000) 

was higher than the rate among whites (121 per 100,000). 

 High Blood Pressure: African Americans in Michigan 

were more likely to report having been told that they have 

high blood pressure than whites (38.9% versus 26.0%).

Chronic Disease Highlight:

Obesity and Diabetes

Michigan has the third highest obesity rate in the nation. 

According to 2003 data from CDC’s Behavioral Risk Factor 

Surveillance System (BRFSS), 25.2% of adults are obese in 

Michigan, compared to the national average of 22.8%. 

Contributing to the problem of obesity are the risk factors of 

poor nutrition and physical inactivity. In 2003, 21.8% of adults 

in Michigan reported having no leisure time physical activity at 

all; the corresponding rate for adults in the United States was 

23.1%. In addition, one third of Michigan students in grades 9 

through 12 did not participate in the recommended amount of 

both moderate and vigorous physical activity during the week. 

Nearly 80% of adults in Michigan reported consuming less than 

5 servings of fruits and vegetables per day, compared to the 

national rate of 77.5%.

Diabetes is a chronic disease that is strongly related to obesity. 

In 2002, 560,000 adults reported that they had diabetes, giving 

Michigan the 8th highest adult diabetes incidence rate in the 

nation. Although the incidence of diabetes in Michigan is high, 

the state’s diabetes death rate—26.9 per 100,000—is close to 

the national average of 25.2 per 100,000. BRFSS data from 

2000 indicated that over a quarter of Michiganders with 

diabetes reported that they were currently taking insulin to treat 

their diabetes. 

A 2003 report by the Michigan Fitness Foundation showed that 

the 4 million adults in Michigan who were physically inactive 

generated costs of nearly $8.9 billion in 2002. Employees—

through health insurance premiums, lost productivity, and 

Medicaid payments—bore most of these costs. In addition, a 

report from the Michigan Department of Community Health 

revealed that in 2002 estimated diabetes-related medical expenditures in Michigan exceeded $4.7 billion, with an additional 

$5.7 billion a year in lost productivity due to premature death, 

disability, and illness.

To address the issues of obesity and diabetes, the Michigan 

Department of Health developed the Michigan Diabetes Strategic 

Plan. The state’s efforts to combat these diseases include expanding diabetes primary prevention activities, developing an 

ongoing public awareness campaign, developing a statewide 

diabetes consumer advisory group, reducing diabetes-related 

health disparities among minority populations, and providing 

quality diabetes pregnancy-related care and education to women.

Text adapted from Michigan Surgeon General’s Health Status Report: 

Healthy Michigan 2010 (2004).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Minnesota

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Minnesota

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Minnesota, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Minnesota

Estimated Cancer Deaths, 2004 

Cause of death US MN

All Cancers 563,700 9,360

Breast (female) 40,110 670

Colorectal 56,730 850

Lung and Bronchus 160,440 2,380

Prostate 29,900 550

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MN

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MN

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 9,360 are expected 

in Minnesota. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 22,720 

new cases that are likely to be diagnosed in Minnesota. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the second leading cause of death in Minnesota, 

accounting for 8,760 deaths or approximately 23% of the state’s 

deaths in 2001 (the most recent year for which data are available). Stroke is the third leading cause of death, accounting for 

2,727 deaths or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Minnesota

Minnesota’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

Minnesota BRFSS

 $253,888 

National Program of Cancer Registries 

 Minnesota Cancer Surveillance System

 $904,262 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Minnesota Heart Disease and Stroke Prevention Initiative

 Cardiovascular Health State Plan

 $335,869 

Diabetes Control Program 

 The Impact of Diabetes in Minnesota

 $900,000 

National Breast and Cervical Cancer Early Detection Program 

 SAGE Screening Program

 $3,619,999 

National Comprehensive Cancer Control Program 

 Comprehensive Cancer Control Planning

 $149,999 

WISEWOMAN $0 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Minnesota Tobacco Prevention and Control Program

 $1,030,395 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $7,194,412 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Minnesota, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Minnesota that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Minnesota’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among African American men (490.1 per 100,000 in 1990 

versus 339.0 per 100,000 in 2000).

 A 13.9% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 30.0% in 1992 to 16.1% in 2002). 

 Prevalence rates that were lower than corresponding 

national rates for smoking (21.1% in Minnesota versus 

22.0% nationally); and for women older than age 18 who 

reported not having had a Pap smear (15.2% in Minnesota 

versus 16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Minnesota in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Minnesota Profiling the Leading Causes of Death in the United States

Disparities in Health

Across the country, American Indians and Alaska Natives 

(AI/ANs) comprise more than 500 federally recognized tribes 

and represent 1% of the U.S. population. Compared with other 

racial and ethnic minorities, AI/ANs have the highest poverty 

rate, 26%, which is 2 times the national rate. In addition to 

high poverty levels, AI/ANs are experiencing growing health 

disparities. 

Minnesota’s AI/ANs make up 1.1% of the state’s population. 

Although they live in one of the healthiest states in the 

country, they experience marked health disparities, and due 

to high poverty rates and economic insecurity, are less likely 

to have continuous health insurance and access to health care 

resources. The 2001 Minnesota Health Access Survey revealed 

that Minnesota’s AI/ANs were more than 3 times more likely 

to be uninsured than whites (16.2% for AI/ANs versus 4.6% 

for whites). Age-adjusted cardiovascular disease death rates 

for Minnesota AI/ANs were considerably higher than all other 

ethnic/racial populations in the state. Between 1998 and 2002, 

the heart disease death rate for AI/ANs was 36% higher than 

the same death rate for non-Hispanic whites. 

Diabetes, a major risk factor for CVD, affects a larger 

percentage of AI/ANs than whites. In 1997, the Indian Health 

Service reported that the age-adjusted prevalence of diagnosed 

diabetes among AI/ANs aged 20 and older among tribes in 

Michigan, Minnesota, and Wisconsin was 15.2%. 

Other Disparities

 Women and Cardiovascular Disease: In Minnesota, 

from 1996 to 2000, Asian/Pacific Islander women aged 

35 and older had the lowest heart disease death rate (150 

per 100,000) compared with African American (313 per 

100,000), AI/AN (378 per 100,000), and white women (290 

per 100,000) in the same age group. Hispanic women aged 

35 and older had the second lowest heart disease death rate 

(199 per 100,000). 

 Stroke: Minnesota’s stroke death rates are 50% higher 

for African Americans and 24% higher for Asian/Pacific 

Islanders than for non-Hispanic whites. Between 1998 and 

2002, African American men had a 53% higher stroke death 

rate than non-Hispanic white men. 

 Diabetes: In Minnesota, Hispanics, who make up 2.9% of 

the population, are 1.7 times as likely as whites to die from 

diabetes. 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

According to CDC mortality data, between 1996 and 2000, 

Minnesota had a heart disease death rate that was lower than 

the national average (384 per 100,000, compared with 536 per 

100,000). Between 1991 and 1998, however, Minnesota had 

a stroke death rate that was higher than the national average 

(125 per 100,000, compared with 121 per 100,000). In 2001, 

there were more than 70,000 hospital discharges in Minnesota, 

with a primary diagnosis of cardiovascular disease (CVD) 

representing more than 11% of all of the discharges. These 

CVD patients incurred total inpatient costs of more than $1.4 

billion. Of these charges, $626 million were due to heart 

disease and $205 million were due to stroke. 

Although Minnesota has low heart disease and stroke death 

rates, the state has focused its attention on lowering the 

prevalence of modifiable risk factors associated with these 

and other chronic conditions. According to 2003 data from 

the Behavioral Risk Factor Surveillance System, 38% of 

Minnesota adults reported being overweight. Of great concern 

is the rising percentage of obese individuals in the state; 

in 1990, 10% of individuals were obese, and by 2003, the 

percentage had grown to 23%. Physical inactivity is also a 

serious problem for children and adolescents. According to the 

2001 Minnesota Student Survey, 12% of 6th graders, 14% of 9th

graders, and 21% of 12th graders reported having no physical 

activity within a given week. Poor nutrition is also a concern. 

In 2003, 24% of Minnesota adults reported eating at least 5 

fruits and vegetables per day. Among youth, approximately 

22% of 6th graders, 15% of 9th graders, and 12% of 12th graders 

reported consuming 5 or more fruits, fruit juices, or vegetables 

per day. In 2003, approximately 22% of adults in Minnesota 

reported that they had been diagnosed with high blood 

pressure—a percentage that has remained constant throughout 

the last decade. 

The Minnesota Heart Disease and Stroke Prevention Plan

2004-2010 was developed to provide a blueprint for collaboration among individuals, communities, and organizations that 

implement strategies to reduce CVD risk factors, incidence, 

complications, and mortality rates. The plan outlines intervention strategies that address environmental and policy change 

at multiple levels of society in addition to strategies aimed at 

improving medical treatment. 

Text adapted from Cardiovascular Disease in Minnesota, 2003 Report and the 

Minnesota Heart Disease and Stroke Prevention Plan 2004-2010.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Mississippi

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Mississippi

350

400

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Mississippi, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Mississippi

Estimated Cancer Deaths, 2004 

Cause of death US MS

All Cancers 563,700 6,230

Breast (female) 40,110 460

Colorectal 56,730 620

Lung and Bronchus 160,440 2,060

Prostate 29,900 440

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MS

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MS

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 6,230 are expected 

in Mississippi. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 15,120 

new cases that are likely to be diagnosed in Mississippi. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Mississippi, accounting 

for 9,050 deaths or approximately 32% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 1,935 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Mississippi

Mississippi’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Mississippi BRFSS

 $174,364 

National Program of Cancer Registries 

 Mississippi Central Cancer Registry

 $343,367 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Know Your Numbers (KYN) Campaign 

 Task Force on Heart Disease and Stroke Prevention

 Mississippi Council on Obesity Prevention and Management

 $394,991 

Diabetes Control Program 

 Diabetes Advisory Council

 $300,000 

National Breast and Cervical Cancer Early Detection Program 

 Mississippi Breast and Cervical Cancer Early Detection Program

 $786,881 

National Comprehensive Cancer Control Program 

 Mississippi Comprehensive Cancer Control Program

 $150,000 

WISEWOMAN $0 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Mississippi Tobacco Prevention and Control Program

 $172,818 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $2,322,421

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Mississippi, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Mississippi that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Mississippi’s Prevention 

Successes

 A 25.3% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 54.0% in 1992 to 28.7% in 2002). 

 A decrease in the percent of women who reported not 

having had a Pap smear in the last 3 years from 19.9% in 

1992 to 18.7% in 2002 and a 2.1% change in the cervical 

cancer death rate from 1997 to 2001.

 A lower mortality rate than the corresponding national rate 

for prostate cancer among white non-Hispanic men (27.9% 

in Mississippi versus 28.1% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Mississippi in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Mississippi Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Mississippi’s cardiovascular disease (CVD) mortality rate is 

the highest in the nation; in 2000, the state’s CVD mortality 

rate was 29% higher than that of the United States. More 

Mississippians die each year from CVD than from all types 

of cancer, traffic injuries, suicides, and AIDS combined. In 

addition, 1 in 5 Mississippians under 65 died of CVD.

In 2001, Mississippi had the highest heart disease death rate in 

the nation and the 5th highest stroke death rate. Between 1996 

and 2000, Mississippi had a heart disease rate that was higher 

than the national average (707 per 100,000, compared with 536 

per 100,000). In addition, between 1991 and 1998, Mississippi 

had a stroke death rate that was higher than the national 

average (140 per 100,000 compared with 121 per 100,000).

As the state’s population ages, the economic impact of CVD 

on Mississippi’s health care system continues to grow. In 

2001, the estimated cost of CVD in Mississippi was about 

$3.7 billion.

Smoking, obesity and physical activity are three risk factors 

that are modifiable through behavior change. According to 

2003 data from CDC’s Behavioral Risk Factor Surveillance 

System, more than a quarter of adults and almost a quarter 

of high school students in Mississippi smoked. In addition, 

Mississippi had one of the highest obesity rates in the nation 

(28.1% compared with 22.1% nationally). Almost one third of 

adults (30.3%) in Mississippi also reported that they did not 

participate in any leisure time physical activity during the past 

month, compared with the national average of 23.1%. 

Mississippi has created several programs to address CVD. 

The Mississippi Cardiovascular Health Program (MCVH) and 

the Mississippi Chronic Illness Coalition (MCIC) developed 

and implemented the Know Your Numbers (KYN) media 

campaign, which encourages Mississippians to monitor their 

blood pressure, cholesterol, glucose, and body mass index. 

The state’s Task Force on Heart Disease and Stroke Prevention 

and the Mississippi Council on Obesity Prevention and 

Management, created through passage of legislation developed 

by MCIC partners, were organized to develop a comprehensive 

statewide plan to address these critical public health problems. 

Text adapted from the Mississippi Department of Health Web site: 

http://www.msdh.state.ms.us/msdhsite/index.cfm/43,0,91,149,html.

Disparities in Health

African Americans make up approximately 38% of Mississippi’s 

population. They have a higher stroke mortality rate than other 

groups, as well as a higher prevalence of the risk factors for 

heart disease. Historically, Mississippi has reported the lowest 

per capita income and median family income of any state 

in the nation, with corresponding high unemployment and 

low educational levels. Nationally, African Americans tend 

to have higher poverty rates and Mississippi is no different. 

These economic disparities translate into health disparities for 

Mississippi’s African Americans.

Heart disease has been the leading cause of death for African 

Americans in Mississippi for many years, followed by cancer 

and stroke. Between 1996 and 2000, African Americans had 

a higher heart disease death rate than their white counterparts 

(823 per 100,000, compared with 667 per 100,000). In 2000, 

African American men had a cancer death rate that was higher 

than white men (366.6 per 100,000, compared with 282.0 per 

100,000) and African American women had a higher cancer 

death rate than white women (186.3 per 100,000, compared with 

167.5 per 100,000). Stoke death rates in Mississippi between 

1991 and 1998 also were higher among African Americans (183 

per 100,000) than whites (125 per 100,000).

African Americans in Mississippi also have higher rates of the 

risk factors for CVD and cancer, including obesity, physical 

inactivity, and hypertension. According to 2003 data from 

CDC’s Behavioral Risk Factor Surveillance System, African 

Americans were more likely to be obese (36.6%), compared 

with whites (24.1%). In addition, African Americans were less 

likely to report having participated in leisure time physical 

activity during the last month (34.4% versus 27.8%). African 

Americans in Mississippi also were more likely to report having 

been told that they had high blood pressure than whites (39.7%, 

compared with 30.4%).

Other Disparities

 Diabetes: In Mississippi, African Americans are almost 

twice as likely as their white counterparts to have been 

told by a doctor that they have diabetes (15% for African 

Americans versus 9% for whites).

 Cholesterol Screening: Approximately 29% of African 

Americans in Mississippi report that they have never had 

their blood cholesterol checked, compared with 24% of their 

white counterparts.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Missouri

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Missouri

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Missouri, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Missouri

Estimated Cancer Deaths, 2004 

Cause of death US MO

All Cancers 563,700 12,480

Breast (female) 40,110 870

Colorectal 56,730 1,250

Lung and Bronchus 160,440 3,780

Prostate 29,900 450

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MO

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MO

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 12,480 are expected 

in Missouri. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 30,290 

new cases that are likely to be diagnosed in Missouri. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Missouri, accounting 

for 16,633 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 3,796 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Missouri

Missouri’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Missouri BRFSS

 $213,352 

National Program of Cancer Registries 

 Missouri Cancer Registry

 $1,287,204 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Work Site Inventory Program

 Community Policy and Environmental Change Program

 Hearts N’ Parks

 $1,250,001 

Diabetes Control Program 

 Missouri DPCP Diabetes Workgroup

 Missouri DPCP Task Force

 Missouri DPCP Advisory Committee

 $450,000 

National Breast and Cervical Cancer Early Detection Program 

 Missouri Department of Health and Senior Services

 $3,089,531 

National Comprehensive Cancer Control Program 

 Bureau of Cancer Control

 $134,605 

WISEWOMAN

 New Leaf...Choices for Healthy Living

 Show Me Healthy Women

 $239,788 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Missouri Tobacco Prevention and Control Program

 $1,207,523 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Move For Your Youth

 PACE Training

 SHAPE UP Missouri/Walk Across Missouri

 $441,035 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Missouri Coalition for Primary Care

 $891,641 

Total $9,204,680

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Missouri, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Missouri that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Missouri’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decreases occurring 

among African American men (433.6 per 100,000 in 1990 

versus 371.5 per 100,000 in 2000).

 A 14.8% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 38.9% in 1992 to 24.1% in 2002). 

 Lower prevalence rates than the corresponding national 

rates for self-reported overweight (35.6% in Missouri 

versus 36.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Missouri in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Missouri Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death in 

Missouri among all racial and ethnic groups and for both men 

and women. CDC mortality data indicate that in 2001, Missouri 

had the 12th highest heart disease death rate in the nation and 

the 18th highest stroke death rate. In addition to the cost in 

lives, the Missouri Department of Health reports that CVD 

also costs more than $1 billion in hospitalizations per year. 

The largely preventable nature of this disease makes the 

deaths associated with CVD even more tragic. Behavioral 

modifications, such as participating in physical activity, 

practicing good nutritional habits, quitting smoking, and 

maintaining a healthy weight substantially reduce one’s risk 

of suffering from CVD. Behavioral Risk Factor Surveillance 

System data from 2003 indicate that in Missouri, only 20.2% of 

adults consumed 5 or more servings of fruits and vegetables per 

day and 54.9% did not meet the recommended guidelines for 

moderate physical activity. Almost 60% of Missouri adults were 

overweight (35.6%) or obese (23.6%), and more than a quarter 

of adults in the state were smokers (27.2%). More than 33.0% 

of adults in Missouri reported that they been told that they have 

high blood cholesterol, and 27.5% reported having been told 

that they have high blood pressure.

Despite remarkable declines in Missouri’s overall CVD 

mortality rates since 1950, certain segments of the population 

have not benefited equally. Of particular concern are African 

Americans who experience considerably higher rates of 

heart disease and stroke than whites. According to CDC’s 

Cardiovascular Health Program data, from 1996 to 2000, the 

heart disease death rate for African Americans in Missouri (745 

per 100,000) was higher than the heart disease death rate for 

whites (585 per 100,000). In addition, the stroke death rate for 

African Americans (156 per 100,000) was also higher than the 

corresponding rate for whites (124 per 100,000).

To address the problem of CVD in Missouri, the state 

implemented the Mississippi Cardiovascular Health Program, 

which has received funding from the CDC since 1998. The 

program works to develop and coordinate partnerships, develop 

an inventory of policy and environmental strategies, provide 

training and technical assistance to local communities, develop 

population-based strategies, and develop culturally competent 

strategies for priority populations.

Text adapted from The Missouri Cardiovascular Health State Plan 2000-2010.

Disparities in Health 

Heart disease is the leading cause of death among women in 

the United States. According to CDC’s Cardiovascular Health 

(CVH) data, Missouri’s overall cardiovascular disease death 

rate is declining. However, for women in Missouri aged 35 

and older, the heart disease death rate increased—from 430 per 

100,000 between 1991 and 1995 to 488 per 100,000 between 

1996 and 2000). This increase particularly affected African 

American women (whose rates rose from 585 per 100,000 to 

641 per 100,000 during the same periods) and Hispanic women, 

(whose rates rose from 248 per 100,000 to 328 per 100,000). 

According to 2003 data from CDC’s Behavioral Risk Factor 

Surveillance System, in Missouri, 74.4% of women consume 

less than 5 servings of fruits and vegetables per day. 

Additionally, 55.9% of women in Missouri report not engaging 

in moderate physical activity, while 81.7% report not engaging 

in vigorous physical activity. More than 23% of Missouri’s 

women are smokers, and 28% have high blood pressure. 

According to the Missouri Department of Health and Senior 

Services’ Office of Women’s Health, in 2002, more than half 

of the state’s nonwhite women (55%) were overweight and 

slightly more than one third (38%) of white women were 

overweight.

Other Disparities

 Colorectal Cancer: In Missouri in 2000, African American 

women had higher colorectal cancer death rates (23.1%) 

than white women (17.8%). 

 Cervical Cancer: In 2002, African American women were 

more likely to report having had a Pap smear in the last 3 

years than white women (92.2% compared with 80.1%), 

however, between 1997 and 2001, African American 

women in Missouri had a higher cervical cancer death rate 

than white women (6.3 per 100,000 compared with 2.4 per 

100,000). 

 Mammography Screening: In 2002, Missouri had a 

higher prevalence rate than the corresponding national rate 

for women over the age of 50 who reported not having 

had a mammogram in the last 2 years (24.1% in Missouri 

versus 20.4% nationally). However, for the same year, the 

prevalence rate for African American women over the age 

of 50 who reported not having had a mammogram in the 

last 2 years was lower than the corresponding national rate 

for African Amercan women (14.8% in Missouri versus 

18.2% nationally). 
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Montana

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Montana

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Montana, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Montana

Estimated Cancer Deaths, 2004 

Cause of death US MT

All Cancers 563,700 2,060

Breast (female) 40,110 110

Colorectal 56,730 180

Lung and Bronchus 160,440 600

Prostate 29,900 140

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US MT

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US MT

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 2,060 are projected 

for Montana. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 5,000 

new cases that are likely to be diagnosed in Montana. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Montana, accounting 

for 1,970 deaths or approximately 24% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the fourth leading cause of death, accounting for 578 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Montana

Montana’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

 Montana BRFSS

 $209,204 

National Program of Cancer Registries

 Montana Cancer Registry

 $239,844 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Montana Cardiovascular Disease Prevention and Control Plan 2000

 Cardiovascular Disease/Obesity Prevention Task Force

 Cardiovascular Health Summit

 $913,797 

Diabetes Control Program 

 Chronic Disease Prevention and Health Promotion Programs

 $616,997 

National Breast and Cervical Cancer Early Detection Program 

 Health Policy and Services Division

 $1,751,293 

National Comprehensive Cancer Control Program $0 

WISEWOMAN $0 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Montana Tobacco Prevention Information

 $825,415 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $4,556,550

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Montana, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Montana that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Montana’s Prevention 

Successes

 Stastically significant decreases in cancer deaths among 

women across all races (173.0 per 100,000 in 1990 versus 

160.6 per 100,000 in 2000). Among men across all races, 

there was a decrease in cancer deaths, although the decrease 

was not statistically significant (250.5 per 100,000 in 1990 

versus 242.2 per 100,000 in 2000). 

 A 13.5% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 37.3% in 1992 to 23.8% in 2002). 

 Lower prevalence rates than the corresponding national rates 

for self-reported diabetes (5.5% in Montana versus 7.1% 

nationally) and for self-reported obesity (18.8% in Montana 

versus 22.8% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Montana in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Montana Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD), including coronary heart disease 

and stroke, is the number one cause of death in the state of 

Montana and accounted for 30.8% of all the state’s deaths in 

2001. The age-adjusted death rate for heart disease in Montana 

from 1996 to 2000 was 431 per 100,000. The age-adjusted 

death rate for stroke in Montana from 1996 to 2000 was 124 

per 100,000, which was higher than the national rate of 121 per 

100,000. In Montana, the number of hospitalizations for heart 

attacks increased slightly, from 2,512 in 1995 to 2,642 in 2000.

According to data from CDC’s 2003 Behavioral Risk Factor 

Surveillance System, 21.3% of the population reported that 

they had been diagnosed with high blood pressure, and 29.8% 

reported that they had high blood cholesterol. More than 20.0% 

of Montanans did not consume 5 or more servings of fruits and 

vegetables per day and 41.5% of adults in Montana did not meet 

the recommended guidelines for moderate physical activity. As 

a result, more than half of Montana’s residents were overweight 

(37.9%) or obese (18.7%). In addition, 20% of Montana adults 

were smokers. A 2003 report by the Montana Cardiovascular 

Health Program indicated that Montanans aged 65 and older 

were at higher risk for a heart attack or stroke, but were less 

likely than younger adults to recognize all the symptoms of 

heart attack and stroke. 

In an effort to address Montana’s CVD problem, the Montana 

Cardiovascular Health Program conducts statewide activities to 

promote cardiovascular health and to prevent cardiovascular 

disease and its associated risk factors, such as physical inactivity, 

obesity, hypertension, and high blood cholesterol. The program 

has assessed existing policies and environmental supports that 

promote cardiovascular health in a variety of settings, including 

schools, worksites, health care institutions, and communities. 

The program has formed a statewide Cardiovascular Disease 

and Obesity Prevention Task Force, has provided resources 

for Montana elementary schools to participate in “Walk to 

School Day,” and sponsored the Cardiovascular Health Summit 

conference for health professionals. The program also promoted 

healthy eating and active lifestyles by co-chairing Eat Right 

Montana, a statewide nutrition and physical activity coalition; 

by implementing a multiyear “Healthy Families” media 

campaign; and by participating in the State Advisory Council on 

Food and Nutrition. 

Text adapted from The Burden of Cardiovascular Disease in the 

State of Montana (2003). 

Disparities in Health

Across the country, American Indians and Alaska Natives 

(AI/ANs) comprise more than 500 federally recognized tribes 

and represent 1% of the U.S. population. Compared with other 

racial and ethnic minorities, AI/ANs have the highest poverty 

rate, 26%, which is twice the national rate. AI/ANs also are 

experiencing increasing health disparities. 

According to the U.S. Census, AI/ANs are Montana’s largest 

minority group and accounted for approximately 6.2% of the 

state’s population in 2000. Data from the Indian Health Service 

on regional trends in Indian health show that, nationally, the life 

expectancy of AI/ANs born today is 70.6 years—almost 6 years 

less than the life expectancy of the U.S. population for all races 

(76.5 years). In the Billings Indian Health Service area, which 

includes Montana and Wyoming, the AI/AN life expectancy is 

67.9 years—more than 8 years lower than the life expectancy of 

the U.S. population as a whole. 

In 2001, Montana’s AI/ANs had higher death rates than whites 

for heart disease and stroke. That year, AI/ANs had the highest 

heart disease death rate in the state (550 per 100,000); this rate 

was also higher than the national average for all races (536 per 

100,000). During the same period, the AI/AN population also 

had the highest stroke death rate (149 per 100,000), a rate that 

was also higher than the stroke death rate for the entire U.S. 

population (121 per 100,000). 

Montana’s AI/AN men had a heart disease death rate that was 

almost twice the rate for AI/AN men nationwide (879 per 

100,000 for AI/AN men in Montana compared with 444 per 

100,000 nationally). Discrepancies in heart disease death rates 

for AI/AN women in Montana and in the United States were 

not as large, but were still higher for AI/AN women in Montana 

(336 per 100,000, compared with 278 per 100,000 nationally).

Other Disparities

 Overweight and High Blood Pressure: A 1999 survey 

of AI/ANs living on or near Montana reservations found 

that more than 60% of respondents age 45 and older were 

overweight and more than 40% had high blood pressure. 

 Diabetes: The 1999 survey found that 13% of AI/ANs age 

18 and older living on or near Montana’s reservations had 

diabetes, compared to 3% for all Montanans. 

 Smoking: In 1998, Montana AI/ANs under age 45 were 

more likely to smoke (42%) than AI/ANs aged 45 and older 

(32%); these rates were higher than the rate for all white 

Montanans (21%). 
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

North Carolina

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States North Carolina

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and North Carolina, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States North Carolina

Estimated Cancer Deaths, 2004 

Cause of death US NC

All Cancers 563,700 16,580

Breast (female) 40,110 1,090

Colorectal 56,730 1,590

Lung and Bronchus 160,440 5,270

Prostate 29,900 930

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NC

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NC

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 16,580 are expected in 

North Carolina. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 40,240 

new cases that are likely to be diagnosed in North Carolina. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in North Carolina, accounting for 18,792 deaths or approximately 26% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 5,401 

deaths or approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States North Carolina

North Carolina’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 North Carolina BRFSS

 $284,325 

National Program of Cancer Registries

 North Carolina Central Cancer Registry

 $700,757 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

Paul Coverdell National Acute Stroke Registry

 $1,540,000 

$755,999

Diabetes Control Program 

 North Carolina Diabetes Prevention and Control Program 

 $876,721 

National Breast and Cervical Cancer Early Detection Program

 Health Promotion and Disease Prevention

 $3,227,933 

National Comprehensive Cancer Control Program

 North Carolina Advisory Committee on Cancer Coordination and Control

$300,000

WISEWOMAN 

 A New Leaf...Choices for Healthy Living 

 $1,250,000 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 North Carolina Tobacco Prevention and Control Program

 $1,672,557 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Local Physical Activity & Nutrition Coalitions (LPAN’s)

 Physical Activity and Nutrition (PAN) Grant Program

 Start With Your Heart NC Cardiovascular Health Program

 Statewide Health Promotion Program

 Sybershop

 Color Me Healthy

 $449,813 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Carolinas Medical Center (Charlotte Mecklenburg Hospital Authority)

 Eastern Band of Cherokee Indians

$924,640

 $774,720 

Total $12,757,465 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for North Carolina, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in North Carolina that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of North Carolina’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among white men (280.6 per 100,000 in 1990 versus 256.0 

per 100,000 in 2000).

 A 20.4% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 37.0% in 1992 to 16.6% in 2002). 

 Lower mortality rates than the corresponding national rates 

for female breast cancer deaths among all races (24.3% in 

North Carolina versus 26.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding needed to implement effective chronic disease prevention programs 

and ensure that all Americans have access to quality health care. 

CDC funding and support enable state health departments to 

respond efficiently to changing health priorities and effectively 

use limited resources to meet a wide range of health needs 

among specific populations. The table below is a breakdown 

of the CDC’s funding awards to North Carolina in the areas of 

cancer, heart disease, stroke, and related risk factors. 
4

North Carolina Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: Diabetes

Diabetes is a chronic disease, that affects the body’s ability to 

produce or respond to insulin. Insulin allows glucose (sugar) 

to enter cells and to be converted to energy. In uncontrolled 

diabetes, glucose and fats remain in the blood, damaging vital 

organs. The number of people with diabetes in North Carolina 

has surpassed one half million and continues to increase. At the 

same time, modifiable risk factors for the disease, such as lack 

of exercise, obesity and overweight, and unhealthy diet, have 

increased in the last decade.

Adult obesity in North Carolina almost doubled from 11.6% in 

1990 to 24.0% in 2003. From 1995 to 2000, the prevalence of 

diagnosed diabetes among adults in North Carolina increased 

42%. In 2000, diabetes was the 5th leading cause of death 

in North Carolina, resulting in 2,078 deaths and, from 1994 

to 2000, a 30% increase in mortality rates. In 2001, CDC 

mortality data indicate that African Americans had a higher 

diabetes death rate than whites (55.5 per 100,000 for African 

Americans, compared with 22.0 per 100,000 for whites). In 

addition, in 2001 men had higher diabetes death rates than 

women (30 per 100,000 for men, compared with 26 per 

100,000 for women).

Physical activity and nutrition are factors that can be modified 

to reduce the risk of developing diabetes. From 1994 to 

2003, the number of adults in North Carolina who reported 

consuming 5 or more servings of fruits and vegetables 

increased from 18.9% to 23.1%. The number of North 

Carolinians who reported engaging in leisure time physical 

activity increased 10.9%; however, in 2003, 25.0% still did not 

engage in leisure time physical activity during the past month.

In North Carolina, diabetes is responsible for approximately 

14,000 hospitalizations per year and 3,000 lower extremity 

amputations per year. In 1998, the estimated hospitalization 

cost for diabetes and related complications in the state totaled 

more than $1.5 billion.

The North Carolina Diabetes Prevention and Control Program 

was developed to address the increased modifiable risk factors 

among the state’s residents. The program works to increase 

awareness of diabetes and its complications, to monitor the 

burden of the disease, to help health care providers improve the 

quality of diabetes education, and to enhance community-based 

efforts to reduce the burden of diabetes through education and 

capacity building.

Text adapted from Diabetes in North Carolina: A Summary Report 2002. 

Disparities in Health

North Carolina’s Hispanic population has experienced rapid 

growth during the past 10 years. Most of this growth can be 

attributed to high levels of migration due to economic opportunities in agriculture, construction, and food industries; this growth 

can also be attributed to high Hispanic birth rates. Estimates of 

the Hispanic population in North Carolina vary, but data from 

the 2000 U.S. Census indicated that people of Hispanic origin 

represented 4.7% of the state’s population—378,963 people.

As is the case with other racial and ethnic minorities, Hispanics 

are disproportionately affected by certain health problems. 

Although injury and homicide are leading causes of death for 

Hispanics, chronic disease disparities also exist, especially for 

diabetes and cardiovascular disease.

Although state-specific data on diabetes and cancer among 

Hispanics are limited, national data indicate that the rate of 

diabetes is increasing. In the United States, diabetes increased 

among the general population from 28 cases per 1,000 in 1986

to 30 cases per 1,000 in 1994. During the same period, the 

increase among Mexican Americans was much higher, increasing from 54 cases per 1,000 to 66 cases per 1,000. 

Risk factors for cardiovascular disease include high blood 

pressure, diabetes, obesity, and high blood cholesterol. In 2003, 

according to CDC’s Behavioral Risk Factor Surveillance data, 

over one quarter of Hispanics in North Carolina reported that 

they had been told they had high blood cholesterol and 8.5% had 

been told they had high blood pressure. These data also indicate 

that 40.2% of Hispanics are overweight and 21.5% are obese. 

Other Disparities

 Obesity: African Americans in North Carolina are more 

likely to be obese than whites (35.0% versus 21.6%).

 Breast and Cervical Cancer: In 2002, African American 

women were more likely to have had a mammogram in 

the last 2 years than white women (86.7% versus 83.0%); 

however, in 2000, African American women in North 

Carolina had a higher breast cancer death rate (31.4 per 

100,000) than white women (22.6 per 100,000). In 2002, 

African American women also were more likely to report 

having had a Pap smear in the last 3 years than white women 

(93.1% versus 85.3%); however, in 2000, African American 

women had a higher cervical cancer death rate (6.7 per 

100,000) than white women (2.6 per 100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

North Dakota

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States North Dakota

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and North Dakota, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States North Dakota

Estimated Cancer Deaths, 2004 

Cause of death US ND

All Cancers 563,700 1,340

Breast (female) 40,110 100

Colorectal 56,730 140

Lung and Bronchus 160,440 330

Prostate 29,900 70

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US ND

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US ND

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 1,340 are expected 

in North Dakota. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 3,250 

new cases that are likely to be diagnosed in North Dakota. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in North Dakota, accounting for 1,700 deaths or approximately 28% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 507 

deaths or approximately 8% of the state’s deaths in 2001 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States North Dakota

North Dakota’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 North Dakota BRFSS

 $163,866 

National Program of Cancer Registries 

 North Dakota Cancer Registry

 $196,567 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $300,000

Diabetes Control Program 

 Diabetes Collaborative

 Diabetes Today

 $269,500 

National Breast and Cervical Cancer Early Detection Program 

 Women’s Way

 $1,053,359 

National Comprehensive Cancer Control Program $150,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 North Dakota Tobacco Prevention and Control Program

 $1,129,745 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $3,263,037

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for North Dakota, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in North Dakota that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of North Dakota’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women of all races. Cancer deaths among men 

decreased from 257.0 per 100,000 in 1990 to 241.4 per 

100,000 in 2000. Among women, cancer deaths decreased 

from 160.8 per 100,000 in 1990 to 142.5 per 100,000 in 2000. 

 A 23.4% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 43.3% in 1992 to 19.9% in 2002). 

 Lower prevalence rates than the corresponding national rates 

for individuals who reported being told by a doctor that they 

had diabetes (6.2% in North Dakota versus 7.1% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to North Dakota in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

North Dakota Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Child and Adult Obesity

Many young children, adolescents, and young adults in North 

Dakota are overweight because today’s lifestyles promote poor 

eating habits and physical inactivity. In 1999, about 8% of 

North Dakotan children ages 3 to 4 in the Women, Infants, and 

Children (WIC) program were overweight (greater than the 

95th percentile in weight for height). Between 1993 and 1999, 

the percentage of overweight American Indian/Alaska Native 

children in this age group was almost double the percentage for 

their white counterparts. 

Data from CDC’s Youth Risk Behavior Survey show that in 

1999, about 20% of teens in North Dakota were overweight 

or were at risk of becoming overweight (greater than the 85th 

percentile body mass index [BMI]); in contrast, more than 40% 

of the state’s teen girls thought they were overweight and more 

than 60% were trying to lose weight. A perception of being 

overweight and dieting to lose weight put many of these teens 

at risk of developing an eating disorder. Only 45% of young 

adults in North Dakota aged 20 to 24 had a BMI of 20 to 24.9, 

which is considered a healthy weight. Adults in North Dakota 

also have weight problems. Data from CDC’s 2002 Behavioral 

Risk Factor Surveillance System indicate that 38.2% of adults in 

North Dakota were overweight (compared with 37.0% of adults 

nationally), and 23.4% were obese (compared with 22.2% of 

adults nationally).

In response to this problem, the North Dakota Department 

of Health’s Division of Maternal and Child Health (MCH) 

provides a number of collaborative activities to promote healthy 

weight and a healthy lifestyle to North Dakota’s residents. An 

MCH staff member leads an Obesity Prevention Work Group 

(OPWG) comprising programs from several public and private 

agencies. Among its many activities, the OPWG sponsors 

conferences such as the 2001 Eat Well, Play More: Promoting 

Healthy Weight in North Dakota Children. MCH also supports 

the development of the 5 Plus 5 Communities through the 

North Dakota Health Heart Council. The 5 Plus 5 Communities 

work to encourage North Dakotans to eat 5 servings of fruits 

and vegetables per day, and to increase physical activity to 30 

minutes per day, 5 days per week. In addition to the OPWG, 

staff members from the Special Nutrition Program for WIC are 

promoting behaviors that prevent obesity.

Text adapted from Promoting Healthy Weight: Maternal and 

Child Health Fact Sheet (n.d.).

Disparities in Health

Across the country, American Indians and Alaska Natives (AI/

ANs) comprise more than 500 federally recognized tribes and 

represent 1% of the U.S. population. In North Dakota, almost 

5% of the population is AI/AN. Compared with other racial and 

ethnic minorities AI/ANs have the highest poverty rate, 26%, 

which is 2 times the national rate. In addition to high poverty 

levels, AI/ANs are experiencing increasing health disparities.

American Indians/Alaska Natives in North Dakota and the 

surrounding region have the shortest average life span of 

AI/ANs in the United States. Many believe this is due to 

inadequate health care for this population. According to the 

Center for Rural Health, on average, AI/ANs in North Dakota 

live to be 64 years old—12 years less than the average life span 

of 76 years for the AI/AN population in California, and 13 

years less than the national average of 77 years.

In 2001, the leading causes of death for AI/ANs in North 

Dakota were cancer, heart disease, accidents, diabetes, and 

chronic liver disease. Cancer accounted for 20% of all AI/AN 

deaths, and heart disease accounted for 19% of all AI/AN 

deaths. AI/ANs in North Dakota have a heart disease death rate 

that is considerably higher than the rate for whites (792 per 

100,000 versus 449 per 100,000), and they have a stroke death 

rate that is also higher than that of whites (141 per 100,000 

versus 121 per 100,000). Diabetes is a preventable cause of 

death that accounted for 7.6% of AI/AN deaths in North Dakota 

in 2001, compared with only 3.1% of deaths among whites 

in North Dakota. In addition, chronic liver disease, the fifth 

leading cause of death for the state’s AI/ANs, accounted for 

6.6% of AI/AN deaths in North Dakota in 2001. Among whites 

in North Dakota, chronic liver disease was not among the top 

10 causes of death in 2001.

Data on other disparities in North Dakota are limited, but other 

disparities affecting AI/ANs in the United States are provided 

below.

Other Disparities

 Exercise: AI/AN women are less likely to exercise than 

their male counterparts (43% of AI/AN women and 34% of 

AI/AN men do not exercise). 

 Obesity: AI/AN women are more likely to be obese (42%) 

than their male counterparts (36%). 

 Smoking: AI/AN men are more likely to smoke (30%) than 

their female counterparts (24%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Nebraska

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Nebraska

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Nebraska, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States Nebraska

Estimated Cancer Deaths, 2004 

Cause of death US NE

All Cancers 563,700 3,410

Breast (female) 40,110 240

Colorectal 56,730 390

Lung and Bronchus 160,440 960

Prostate 29,900 190

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NE

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NE

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Source: American Cancer Society, 2004

The Leading Causes of Death and Their Risk Factors

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 3,410 are expected 

in Nebraska. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 8,280 

new cases that are likely to be diagnosed in Nebraska. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Nebraska, accounting 

for 4,150 deaths or approximately 27% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death in Nebraska, accounting for 

1,130 deaths or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Nebraska

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Nebraska BRFSS

 $190,340 

National Program of Cancer Registries 

 Nebraska Department of Health and Human Services

 $218,083 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 S.T.E.P.S. (Strategies Toward Environment and Policy Success) for a Healthy Heart

 $337,373 

Diabetes Control Program 

 Be Smart About Your Heart: Control the ABCs of Diabetes

 Small Steps, Big Rewards

 Control Your Diabetes for Life

 $297,181 

National Breast and Cervical Cancer Early Detection Program

 Every Woman Matters 

 $2,909,048 

National Comprehensive Cancer Control Program 

 Comprehensive Cancer Control Program

 $142,683 

WISEWOMAN

 ABCs for Good Health

 Be a WISEWOMAN - Get Heart Smart!

 $874,580 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 Nebraska Tobacco Prevention and Control Program 

 $1,199,489 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $6,168,777

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Nebraska, FY 2003 

Nebraska’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Nebraska that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Nebraska’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

men across all races (256.3.0 per 100,000 in 1990 versus 

231.2 per 100,000 in 2000). 

 A 25.6% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 49.1% in 1992 to 23.5% in 2002). 

 A mortality rate that was lower than the corresponding 

national rate for female breast cancer deaths for all races 

(22.2% in Nebraska versus 26.7% nationally), and a higher 

prevalence rate than the corresponding national rate for 

leisure time physical activity (79.3% in Nebraska versus 

76.9% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Nebraska in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Nebraska Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Obesity and Physical Activity 

Between 1990 and 2000, obesity among Nebraska’s adults 

increased 83%. During that time, in addition to the 21% of 

Nebraska adults who were obese, 38% were identified as 

overweight, making approximately 3 of every 5 Nebraskans—

nearly 750,000 adults—either overweight or obese. 

Obesity is a risk factor for four of Nebraska’s six leading 

causes of death—heart disease, diabetes, stroke, and 

cancer. Obesity is also associated with conditions such as 

hypertension, gallbladder disease, osteoarthritis, sleep apnea, 

asthma, and high blood cholesterol. 

The number of Nebraskans affected by cardiovascular 

disease, cancer, and diabetes is growing and has serious 

financial ramifications for the state. The total estimated 

costs in Nebraska for these diseases were $2.1 billion for 

cardiovascular disease in 2002, $972 million for cancer in 

2001, and $610 million per year for diabetes in 2001. 

To reverse these trends, Nebraska has adopted several 

initiatives to encourage physical activity. These initiatives 

include the Governor’s Council on Health Promotion and 

Physical Fitness and a Physical Activity Program to encourage 

Nebraskans to be physically active for at least 30 minutes a day.

Disparities in Health

The Hispanic population in Nebraska is the largest and most 

rapidly expanding minority group in the state. According to 

the U.S. Census, from 1990 to 2000, Nebraska’s Hispanic 

population increased by 155.4% and now represents 5.5% of 

the state’s population. Nebraska’s African American population, 

which grew by 19.4% during the same time, represents 4.0% of 

the population, and the American Indian/Alaska Native (AI/AN) 

population, which grew by 20%, represents approximately 1% 

of the state’s population. According to the 2000 U.S. Census, 

Nebraska’s AI/AN population has the state’s highest poverty 

rates (33.0%), followed by African Americans (27.4%). 

A 2003 report by the Nebraska Department of Health and 

Human Services, Office of Minority Health and Human 

Services, indicates that heart disease is the leading cause of 

death among African Americans and AI/ANs in Nebraska. The 

state’s AI/ANs have the highest heart disease death rate (435.7 

per 100,000) and are 1.9 times as likely to die of heart disease as 

whites; African Americans, who have the second highest heart 

disease death rate (280.4 per 100,000), are 1.2 times as likely to 

die of heart disease as whites. The stroke death rate in Nebraska 

is 1.6 times higher for African Americans than for whites; 

for AI/ANs, the rate is 1.3 times higher than that of whites. 

According to CDC mortality data, in 2000, African American 

men in Nebraska also had a higher cancer death rate than white 

men (297.5 per 100,000, compared with 257.7 per 100,000). 

Smoking is a risk factor for cancer, heart disease, and stroke. 

According to the CDCs Behavioral Risk Factor Surveillance 

System 2003 data for Nebraska, African Americans (22.6%) are 

more likely to smoke than whites (21.1%) or Hispanics (16.2%). 

Other Disparities

 Diabetes: In Nebraska, AI/ANs are 4.9 times more likely 

to die of diabetes-related causes than whites. The state’s 

diabetes-related death rate for African Americans is 2.4 times 

greater than the rate for whites and the rate for Hispanics is 

1.6 times greater than the rate for whites.

 Cirrhosis: Nebraska’s AI/ANs are more likely to die from 

liver disease than whites. Liver disease is the 4th leading 

cause of death among AI/ANs in Nebraska and the 16th 

leading cause of death for whites.

 Obesity: AI/ANs (50.9%), African Americans (33.4%), and 

Hispanics (27.2%) are more likely to be obese than whites 

(23.2%). 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Source: BRFSS

Text and figure adapted from Governor’s Report: Promoting Better Health for 

Young People in Nebraska through Physical Activity (May 2003). 

US NE

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

20%

10%

25%

15%

Obesity Trend Among NE and U.S. Adults Based on BMI*, 1990-2000

*Body Mass Index (weight in kilograms divided by height in meters squared) of 

30 or greater.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Nevada

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Nevada

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Nevada, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Nevada

Estimated Cancer Deaths, 2004 

Cause of death US NV

All Cancers 563,700 4,530

Breast (female) 40,110 300

Colorectal 56,730 480

Lung and Bronchus 160,440 1,450

Prostate 29,900 260

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NV

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NV

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 4,530 are expected 

in Nevada. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 10,990 

new cases that are likely to be diagnosed in Nevada. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Nevada, accounting 

for 4,393 deaths or approximately 27% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the fourth leading cause of death, accounting for 913 deaths 

or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Nevada

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Nevada BRFSS

 $221,376 

National Program of Cancer Registries 

 Nevada Central Cancer Registry

 $647,325 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program

 Nevada Diabetes Prevention and Control Program

 $457,970 

National Breast and Cervical Cancer Early Detection Program 

 Women’s Health Connection

 $2,654,762 

National Comprehensive Cancer Control Program 

 Nevada Comprehensive Cancer Program

 $143,336 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Nevada Tobacco Prevention and Control Program 

 $697,562 

State Nutrition and Physical Activity/Obesity Prevention Program (No CDC Funding) $0

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

 University of Nevada, Reno $857,404 

Total $5,679,735 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Nevada, FY 2003 

Nevada’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Nevada that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Nevada’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decreases occurring 

among African American men (336.4 per 100,000 in 1990 

to 318.3 per 100,000 in 2000).

 An 18.3% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 40.4% in 1992 to 22.1% in 2002). 

 Lower prevalence rates than the corresponding national 

rates for individuals who reported having been told by 

a health care provider that they had high blood pressure 

(23.6% in Nevada versus 24.8% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Nevada in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Nevada Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Diabetes

Diabetes is a common disease in Nevada. In 2002, 104,466 

adults, or 6.2% of adults, in the state had diabetes that had been 

diagnosed; however, an estimated 430,000 people in Nevada 

were at increased risk for undiagnosed diabetes due to risk 

factors such as age, obesity, and sedentary lifestyle. 

People with diabetes suffer from many diabetes-related 

complications. In 2002, there were 3,272 diabetes-related 

hospitalizations, and 267 lower extremity amputations were 

performed in Nevada. In addition, diabetes was listed as 

the leading cause of death for 319 residents of Nevada in 

2001. The cost of diabetes in Nevada is staggering: in 2002, the 

direct cost of diabetes hospitalizations was about $82 million. 

Diabetes also is more prevalent among racial and ethnic 

minorities. Data from CDC’s 2003 Behavioral Risk Factor 

Surveillance System (BRFSS) indicate that more than 10.0% 

of African Americans in Nevada reported that they have been 

diagnosed with diabetes, compared with only 6.6% of whites 

and 5.6% of Hispanics. However, BRFSS data from 1996 to 

2001 on diabetes prevention activities found that the state’s 

African Americans were obtaining necessary care. Over 

80% received a foot exam each year (the Healthy People 

2010 objective is 75%) and 78.8% received an eye exam 

(the Healthy People 2010 objective is 75%). In contrast, the 

Hispanic population was less likely to obtain this care: only 

70.8% of Hispanics with diabetes had at least one foot exam 

and only 63.3% had an eye exam.

The Nevada Diabetes Council was created in 1997 by the 

State of Nevada’s Division of Health to address state concerns 

about diabetes. The council’s purpose is to serve as a voluntary, 

nongovernmental body of concerned citizens, private and 

public organizations, agencies, business leaders and consumers

working together to formulate a cohesive plan for reducing the 

burden of diabetes in Nevada and to provide guidance to the 

Nevada Diabetes Prevention and Control Program. The goals 

of the council are to increase public awareness of the impact 

of diabetes, improve the quality of life for those affected by 

diabetes, and reduce the burdens imposed by the disease. 

Text adapted from African Americans & Diabetes in Nevada (n.d.), and Diabetes 

Control Program, Information (n.d.), available on the Nevada State Health Division 

Web site at http://health2k.state.nv.us/diabetes/information.htm. 

Disparities in Health

Women represent just under half of Nevada’s population 

(49.1% according to the 2000 U.S. Census). Nevada pays 

special attention to women in public health planning, not only 

because of their individual health concerns, but also because 

they most often act as the primary caregivers for children.

Nationally, and in Nevada, heart attack, stroke, and other 

cardiovascular diseases are women’s primary health issues. 

Nationally, more women die from heart disease each year 

than from breast, ovarian, and uterine cancer combined. Lung 

cancer is the leading cancer killer of women, taking the lives of 

approximately 62,000 women each year, and colorectal cancer 

is the third leading cause of cancer deaths in women, killing 

almost 30,000 women each year.

In Nevada from 1996 to 2000, women had higher rates of heart 

disease (449 per 100,000) than the national rates for women

(438 per 100,000). Women in Nevada in 2000 also had higher 

lung cancer death rates (56.1 per 100,000) than the national 

rates of lung cancer death for women (41.2 per 100,000). 

Risk factors for heart disease and cancer include poor nutrition, 

physical inactivity, high blood pressure, and smoking. Data 

from CDC’s Behavioral Risk Factor Surveillance System 

indicate that in 2003, women in Nevada were less likely to 

consume 5 or more servings of fruits and vegetables per day 

(24.5%), compared to the national rate for women (27.0%) 

and were more likely to smoke (21.3% for women in Nevada 

versus the national rate for women, 20.3%). Women in Nevada 

were more likely to report that they had been diagnosed with 

high blood pressure than men (24.3% for women versus 

22.9% for men) and were less likely to meet the recommended 

guidelines for moderate physical activity than men (48.7% for 

women versus 52.9% for men). 

Other Disparities

 Stroke: In Nevada, from 1991 to 1998, African Americans 

had a higher stroke death rate than whites (154 per 100,000 

versus 117 per 100,000).

 High Blood Pressure: African Americans in Nevada are 

more likely to report that they have been diagnosed with 

high blood pressure than whites (35% versus 27%).

 Cancer: In Nevada, in 2000, African American men had 

higher cancer death rates than their white counterparts 

(318.3 per 100,000 for African American men versus 257.7 

per 100,000 for white men).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

New Hampshire

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States New Hampshire

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and New Hampshire, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States New Hampshire

Estimated Cancer Deaths, 2004 

Cause of death US NH

All Cancers 563,700 2,590

Breast (female) 40,110 170

Colorectal 56,730 260

Lung and Bronchus 160,440 740

Prostate 29,900 130

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NH

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NH

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 2,590 are expected in 

New Hampshire. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 6,290 

new cases that are likely to be diagnosed in New Hampshire. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in New Hampshire, 

accounting for 2,835 deaths or approximately 29% of the state’s 

deaths in 2001 (the most recent year for which data are available). Stroke is the third leading cause of death, accounting for 

633 deaths or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States New Hampshire

New Hampshire’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 New Hampshire BRFSS

 $221,900 

National Program of Cancer Registries 

 New Hampshire State Cancer Registry

 $614,930 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 New Hampshire Diabetes Advisory Group

 Diabetes Education Program

 Diabetes Lending Library

 Professional Education Conference

 Statewide Public Information Campaign

 New Hampshire Guidelines for Diabetes Care

 $326,077 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Program

 $1,523,288 

National Comprehensive Cancer Control Program

 Comprehensive Cancer Control Program

 $125,794 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 New Hampshire Tobacco Prevention and Control Program

 $871,372 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $947,217

Total $4,630,578

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for New Hampshire, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in New Hampshire that fall into other health areas. A listing of these programs can be 

found at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of New Hampshire’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

white men (285.9 per 100,000 in 1990 versus 258.5 per 

100,000 in 2000).

 A 12.5% decrease in the number of women older than age 50 

who reported not having had a mammogram in the last 2 years 

(from 30.3% in 1992 to 17.8% in 2002), and a statistically 

significant decrease in the breast cancer death rate from 39.6 

per 100,000 in 1990 to 26.2 per 100,000 in 2000. 

 A lower prevalence rate than the corresponding national rate 

for self-reported diabetes (5.6% in New Hampshire versus 

7.1% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding needed to implement effective chronic disease prevention programs 

and ensure that all Americans have access to quality health care. 

CDC funding and support enable state health departments to 

respond efficiently to changing health priorities and effectively 

use limited resources to meet a wide range of health needs 

among specific populations. The table below is a breakdown of 

the CDC’s funding awards to New Hampshire in the areas of 

cancer, heart disease, stroke, and related risk factors. 
4

New Hampshire Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: Diabetes

According to the CDC’s mortality data, diabetes, the 7th 

leading cause of death in New Hampshire, is also a leading 

cause of blindness, kidney failure, and lower limb amputation. 

In 2002, 6.2% of New Hampshire’s population—58,000 

adults—reported that they had been diagnosed with diabetes. 

This figure is likely to be an underestimate, because it only 

counts adults who have been diagnosed with the disease. It is 

estimated that up to one third of people with diabetes in New 

Hampshire are not aware that they have the disease.

The three main risk factors for diabetes are age, weight, and 

physical inactivity. Data from the CDC’s Behavioral Risk Factor 

Surveillance System indicate that the percent of adults in New 

Hampshire who are overweight has increased from 32.8% in 

1990 to 36.7% in 2003, and the percent of adults who are obese 

has increased from 11.1% in 1990 to 20.2% in 2003. These 

trends are similar to the national trends for overweight and 

obesity. In 2003, almost 20% of New Hampshire adults reported 

having no leisure time physical activity in a given month. 

People with diabetes also are more likely to have risk 

factors for heart disease. In 2001, data collected by the New 

Hampshire Diabetes Education Program found that 64% of 

New Hampshire adults with diabetes reported a history of 

high blood pressure and 57% reported having high blood 

cholesterol. In addition, 17% of New Hampshire adults with 

diabetes were smokers. 

In 2001, there were 15,163 hospitalizations in New Hampshire 

among people with diabetes. In the same year, there were 82 

people with diabetes who had kidney failure and 243 people 

who had a lower extremity amputation. 

There are measures people with diabetes can take to prevent 

diabetes complications, such as obtaining regular eye and 

foot exams. In 2002, 80% of adults with diabetes in New 

Hampshire reported that they had received an eye exam in the 

past year. During the same year, 78% of adults with diabetes 

reported having had at least one foot exam in the past year.

The Diabetes Education Program works to address the issue 

of diabetes in New Hampshire. The mission of the program 

is to prevent or delay the onset of diabetes-related health 

problems by improving quality of care in the systems through 

which most New Hampshire residents receive their health care. 

Activities are targeted primarily at community health centers 

and primary care providers. 

Text adapted from Diabetes in New Hampshire, Issue Brief, June 2004.

Disparities in Health

New Hampshire is a fairly homogenous state—only 4% 

of its population is not white. However, almost 40% of the 

state’s population lives in rural areas where access to and 

use of preventive health services is often low. A 2004 report 

released by the Rural Health and Primary Care Unit of the 

New Hampshire Department of Health and Human Services 

examined the differences in health between rural and urban 

residents. In terms of health outcomes, the overall age-adjusted 

mortality rate of rural residents was comparable to that of 

nonrural residents. The actual mortality rate, however, was 

higher among rural populations, primarily because these 

populations tend to be older. For example, the actual (non-ageadjusted) heart disease death rate in New Hampshire was 259.1 

per 100,000 in rural areas and 202.5 per 100,000 in nonrural 

areas. Actual cancer death rates also were higher among the 

state’s rural population (226.6 per 100,000 versus 178.9 per 

100,000). The age-adjusted rate of hospitalizations for heart 

disease in New Hampshire was higher among the state’s rural 

residents than among nonrural residents (1,104.5 per 100,000 

versus 1,015.1 per 100,000). 

In areas of chronic disease prevention, there were not many 

significant differences between the rural and nonrural 

populations, although the rural population reported slightly 

higher percentages of risk factors. For instance, 24.3% of rural 

residents reported that they had been told they have high blood 

pressure, compared with 22.2% of nonrural residents. The 

proportion of study respondents that reported having diabetes 

was higher in rural areas, but the difference was not statistically 

significant (6.8% for rural residents versus 4.6% for nonrural 

residents). Rural respondents also were more likely to be 

current smokers than nonrural respondents (25.5% versus 

22.9%). 

Data on health disparities among racial and ethnic minority 

populations in New Hampshire are limited. For instance, 

CDC’s Behavioral Risk Factor Surveillance System data do not 

provide enough cases among African American and Hispanic 

populations to make conclusions about risk factors related to 

chronic disease prevention. 

Other Disparities

 Heart Disease: From 1996 to 2000, African Americans 

(306 per 100,000) and Hispanics (131 per 100,000) in New 

Hampshire had lower heart disease death rates than whites 

(496 per 100,000). 
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

New Jersey

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States New Jersey

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and New Jersey, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States New Jersey

Estimated Cancer Deaths, 2004 

Cause of death US NJ

All Cancers 563,700 18,060

Breast (female) 40,110 1,480

Colorectal 56,730 1,840

Lung and Bronchus 160,440 4,720

Prostate 29,900 1,030

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NJ

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NJ

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 18,060 are expected 

in New Jersey. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 43,800 

new cases that are likely to be diagnosed in New Jersey. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in New Jersey, accounting 

for 22,704 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 4,007 deaths 

or approximately 5% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States New Jersey

New Jersey’s Chronic Disease Program Accomplishments

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 New Jersey BRFSS

 $191,919 

National Program of Cancer Registries 

 New Jersey State Cancer Registry

 $1,044,697 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program

 New Jersey Diabetes Prevention and Control Program 

 $311,548 

National Breast and Cervical Cancer Early Detection Program

 New Jersey Breast and Cervical Cancer Control Initiative

 $2,962,215 

National Comprehensive Cancer Control Program

 Office of Cancer Control and Prevention

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 New Jersey Tobacco Prevention and Control Program

 $1,328,173 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,838,552 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for New Jersey, FY 2003 

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in New Jeresy that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of New Jersey’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among Hispanic men (222.9 per 100,000 in 1990 versus 

161.3 per 100,000 in 2000). 

 A 21.6% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 42.9% in 1992 to 21.3% in 2002). 

 A lower prevalence rate than the corresponding national 

rate for self-reported obesity (20.1% in New Jersey versus 

22.8% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to New Jersey in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

New Jersey Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Diabetes

Diabetes is a disease with a prevalence that is closely related 

to age and racial/ethnic background. In New Jersey, the trend 

toward an aging and a more diverse population places a greater 

percentage of the state’s residents at risk for diabetes. Using 

data from the National Health Interview Survey and CDC’s 

Behavioral Risk Factor Surveillance System (BRFSS), the 

estimated number of diabetes cases in New Jersey in 1994 was 

between 378,244 and 393,240. CDC data from 2002 continued 

to show an increase in the prevalence of diabetes. These data 

indicate that New Jersey had the 11th highest prevalence rate of 

diabetes, with 426,000 cases of diabetes reported. The highest 

diabetes prevalence in the state was among individuals aged 45 

to 64, who represented 41% of all diabetes cases. 

Data from the 2003 BRFSS indicate that just over 7% of 

the population in New Jersey reported that they had been 

diagnosed with diabetes, an increase from 4.2% in 1995. 

According to CDC mortality data, in 2001, New Jersey had 

the 12th highest age and race-adjusted diabetes death rate in the 

nation, 28.5 per 100,000.

There are preventive measures people with diabetes can take 

to prevent complications from the disease, such as obtaining 

regular eye and foot exams. According to BRFSS data, of the 

people in New Jersey who reported having diabetes between 

1994 and 1996, only 68.6% reported seeing a health care 

professional 2 or more times during the past year. Of this 

same group, 85% checked their blood glucose levels and 85% 

reported having a foot exam at least once in the last year. In 

addition, over 60% reported having an eye exam in the last 

year.

Diabetes is also more prevalent among racial and ethnic 

minorities. According to CDC data from 2001, New Jersey’s 

African American population had a higher age-adjusted 

diabetes death rate than whites (59.1 per 100,000 versus 25.4 

per 100,000). In 2003, African Americans were almost twice 

as likely as whites to report that they had been diagnosed with 

diabetes (12.3% versus 6.6%). In addition, in 2002, Hispanics 

and African Americans with diabetes were more likely than 

whites to report that they were currently taking insulin to 

treat their diabetes (34.6% of Hispanics and 31.8% of African 

Americans, compared with 17.9% of whites). 

Text adapted from The Burden of Diabetes in New Jersey: 

A Surveillance Report (1999).

Disparities in Health

According to 2000 U.S. Census data, New Jersey is a relatively 

diverse state, with African Americans representing 13.6% 

of the population, Hispanics representing 13.3% of the 

population, and Asian/Pacific Islanders representing 5.7% of 

the population. 

Risk factors for a variety of chronic diseases include high 

blood pressure, poor nutrition, physical inactivity, overweight 

and obesity, and smoking. In almost all of these areas, data 

from the Behavioral Risk Factor Surveillance System indicate 

that in New Jersey, African Americans and Hispanics have 

higher rates of chronic disease risk factors than whites. For 

example, 67.1% of Hispanics and 58.8% of African Americans 

in New Jersey report not meeting the recommended guidelines 

for moderate physical activity, compared with 51.0% of whites. 

African Americans (26.4%) and Hispanics (22.7%) are less 

likely to report consuming 5 or more servings of fruits and 

vegetables per day, compared with whites (27.2%). Because 

of these two risk factors, African Americans and Hispanics are 

more likely to be overweight or obese than whites (68.3% of 

African Americans and 61.1% of Hispanics are overweight or 

obese, compared with 56.5% of whites).

From 1996 to 2000, African Americans in New Jersey had a 

higher heart disease death rate (measured per 100,000) than 

any other group (587 for African Americans, compared with 

549 for whites, 257 for Hispanics, and 194 for Asian/Pacific 

Islanders). Stroke death rates (measured per 100,000) during 

the same period were also higher for African Americans 

than for other groups (141 for African Americans, compared 

with 97 for whites, 59 for Asian/Pacific Islanders, and 54 for 

Hispanics). 

Other Disparities

 Breast Cancer: African American women are more likely 

to report having had a mammogram in the last 2 years than 

whites (95.2% versus 85.3%), but they have higher breast 

cancer death rates (38.0 per 100,000 for African American 

women versus 30.8 per 100,000 for white women).

 Prostate Cancer: African American men have a death rate 

from prostate cancer that is more than twice as the rate for 

white men (71.0 per 100,000 versus 26.8 per 100,000).

 Lung Cancer: African American men have a higher lung 

cancer death rate than white men (97.4 per 100,000 versus 

70.0 per 100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

New Mexico

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States New Mexico

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and New Mexico, 1995 and 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. 

Source: National Center for Health Statistics, 2003

1995 2001 1995 2001 1995 2001

(rates per 100,000) 
2

Profiling the Leading Causes of Death in the United States New Mexico

Estimated Cancer Deaths, 2004 

Cause of death US NM

All Cancers 563,700 3,110

Breast (female) 40,110 190

Colorectal 56,730 320

Lung and Bronchus 160,440 690

Prostate 29,900 220

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NM

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NM

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 3,110 are expected 

in New Mexico. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 7,500 

new cases that are likely to be diagnosed in New Mexico. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in New Mexico, accounting for 3,423 deaths or approximately 24% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the fourth leading cause of death, accounting for 824 

deaths or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States New Mexico

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 New Mexico BRFSS

 $263,310 

National Program of Cancer Registries $0

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0 

Diabetes Control Program 

 Coordinated Approach to Child Health (CATCH)

 Project to Prevent Diabetes Among Hispanic Women

 Diabetes Advisory Council

 Bi-National US/Mexican Border Diabetes Project 

 Clinic Support for Indigent Diabetes Care

 Kitchen Creations Cooking School

 Grant County Project 

 $450,000 

National Breast and Cervical Cancer Early Detection Program

 Breast and Cervical Cancer Screening Program

 $4,016,832 

National Comprehensive Cancer Control Program

 Comprehensive Cancer Program

 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 New Mexico Tobacco Prevention and Control Program

 $1,196,889 

State Nutrition and Physical Activity/Obesity Prevention Program $408,003 

Racial and Ethnic Approaches to Community Health (REACH 2010) 

 Albuquerque Area Indian Health Board, Inc

 Hidalgo Medical Services

 National Indian Council on Aging, Inc.

$285,806

$905,000

$209,754

Total $7,735,594

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for New Mexico, FY 2003 

New Mexico’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in New Mexico that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of New Mexico’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decreases occurring 

among white, non-Hispanic men (251.2 per 100,000 in 1990 

versus 216.7 per 100,000 in 2000).

 A 9.3% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 34.0% in 1992 to 24.7% in 2002). 

 Lower prevalence rates than the corresponding national rates 

for self-reported hypertension (21.1% in New Mexico versus 

24.8% nationally). 

CDC’s Chronic Disease Prevention and Health 

Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to New Mexico in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

New Mexico Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Obesity

Obesity is one of the most serious risk factors for a variety 

of chronic diseases, such as heart disease, diabetes, and 

hypertension. In New Mexico, like other states, the prevalence of 

obesity has been increasing. Behavioral Risk Factor Surveillance 

System (BRFSS) data for New Mexico show that in 1990 the 

rate of adult obesity (defined as a body mass index of 30 or 

greater) was 9.8%; by 2003, the rate had increased to 20.2%. On 

a positive note, adults in New Mexico also were more likely to 

have a healthy weight than the national average. In 2003, 43.4% 

of adults in New Mexico were neither overweight nor obese, 

compared with 40.0% of adults nationally. In addition, in 2003, 

African Americans (33.9%) and Hispanics (23.3%) were more 

likely to be obese than whites (17.3%).

Poor nutrition and physical inactivity are risk factors for obesity. 

BRFSS data from 2003 indicate that 48.7% of people in New 

Mexico, regardless of whether they were obese or not, did not 

meet the recommended guidelines for moderate physical activity 

(the corresponding national rate was 52.8%). In addition, only 

22.4% of people in New Mexico reported consuming 5 or more 

servings of fruits and vegetables per day; the rate for Hispanics 

was even lower (18.1%).

According to the 2001 New Mexico Youth Risk and Resiliency 

Survey, 24% of high school students were overweight (defined 

as a body mass index between 25 and 29.9) or at risk for being 

overweight (defined as between the 85th and 95th percentile 

for body mass index). Even young children in New Mexico are 

increasingly prone to becoming overweight. Data from the 2002 

CDC Pediatric Nutrition Surveillance System revealed that 22% 

of low-income children in New Mexico between the ages of 2 

and 5 who participated in federally-funded nutrition programs 

were overweight or at risk for being overweight.

To address the problems of overweight and obesity in New 

Mexico, the state received CDC funding in 2003 for the Obesity, 

Physical Activity & Nutrition program to help support the 

development of a comprehensive New Mexico Plan for Obesity 

Control and Prevention. The goal of the program is to prevent 

and control obesity and related chronic diseases such as diabetes, 

heart disease, arthritis, and some cancers. Most recently, the 

program has formed an obesity Physical Activity and Nutrition 

Forum Planning Group and held the second annual obesity 

symposium for health care providers. 

Youth data from the New Mexico Department of Health Web site: 

www.health.state.nm.us/obesity.html. 

Disparities in Health

Hispanics represent approximately 13% of the U.S. population. 

According to the 2000 Census, this population, which increased 

by more than 50% from 1990 to 2000, is the fastest growing 

ethnic group in the United States. Data from the 2000 Census 

indicate that almost half (42.1%) of New Mexico’s population is 

of Hispanic origin. 

The health status of Hispanics in New Mexico mirrors the 

population’s health status trends throughout the United States. 

In 2001, the leading causes of death for Hispanics, nationally, 

were heart disease and cancer. During this same period, 27.1% 

of all deaths among Hispanic men and 32.6% of deaths among 

Hispanic women were attributed to cardiovascular disease. 

According to the American Cancer Society, Hispanics in the 

United States experience lower incidence and death rates for all 

cancers combined but also experience a higher burden of certain 

types of cancers, such as cervical cancer. 

Cancer mortality data from 2000 indicate that New Mexico’s 

Hispanics have the lowest mortality rates for cancer; 200.9 per 

100,000 for Hispanic men versus 212.6 per 100,000 for white 

men and 136.7 per 100,000 for Hispanic women versus 149.9 

per 100,000 for white women. In addition, between 1997 and 

2001, death rates for breast, cervical, and prostate cancers have 

been stable among Hispanics, but during the same time period, 

they have been decreasing among non-Hispanic whites. 

Diabetes prevalence is high within the Hispanic population, 

both in New Mexico and nationally. Data from CDC’s 2003 

Behavioral Risk Factor Surveillance System (BRFSS) indicate 

that Hispanics in New Mexico had a higher diabetes incidence 

rate (6.2%) than whites (4.8%) and African Americans (3.6%). 

Other Disparities

 Physical Activity: Hispanics have the lowest rates of 

physical activity (69.3%), compared with African Americans 

(82.6%) and whites (80.8%). 

 Cervical Cancer: Although BRFSS data from 2002 

indicate that Hispanic women in New Mexico were more 

likely to have had a Pap smear in the last 3 years (83.7% 

versus 78.8%), from 1997 to 2001, Hispanic women had a 

higher cervical cancer death rate than white women (3.2 per 

100,000 versus 2.5 per 100,000).

 Colorectal Cancer Screening: In 2002, Hispanics had the 

lowest rates of screening for colorectal cancer—61.8% had 

never had a sigmoidoscopy or colonoscopy, compared with 

African Americans (46.2%) and whites (52.9%). 
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

New York

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States New York

350

400

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and New York, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States New York

Estimated Cancer Deaths, 2004 

Cause of death US NY

All Cancers 563,700 36,340

Breast (female) 40,110 2,820

Colorectal 56,730 3,820

Lung and Bronchus 160,440 9,250

Prostate 29,900 1,880

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US NY

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US NY

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 36,340 are expected 

in New York. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 88,190 

new cases that are likely to be diagnosed in New York. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in New York, accounting 

for 56,643 deaths or approximately 36% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 7,706 deaths 

or approximately 5% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States New York

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 New York BRFSS

 $178,192 

National Program of Cancer Registries 

 New York State Cancer Registry

 $1,965,877 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 New York’s Healthy Heart Program 

 Cardiac Advisory Committee 

 $1,340,000 

Diabetes Control Program 

 Diabetes Control and Prevention Program 

 $900,000 

National Breast and Cervical Cancer Early Detection Program

 Breast and Cervical Cancer Early Detection Program

 $6,784,816 

National Comprehensive Cancer Control Program

 Comprehensive Cancer Control Program

 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 New York Tobacco Prevention and Control Program

 $2,086,892 

State Nutrition and Physical Activity/Obesity Prevention Program

 Commissioner’s Physical Activity Challenge

 Eat Well Play Hard

 Healthy Heart Coalitions

 Move for Life

 Pedestrian Road Shows

 Worksite Wellness Programs

 Mini Grants for Faith Based Communities

 Healthy Heart Projects for Growing Healthy Communities

 BC Walks

 $397,222 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Institute for Urban Family Health

 Trustees of Columbia University

 $924,706 

 $885,000 

Total $15,462,705

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for New York, FY 2003 

New York’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in New York that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of New York’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

African American men (345.0 per 100,000 in 1990 versus 

269.2 per 100,000 in 2000) and African American women 

(192.1 per 100,000 in 1990 and 163.6 per 100,000 in 2000).

 A 19.3% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 37.2% in 1992 to 17.9% in 2002). 

 A higher prevalence rate than the corresponding national 

rate for individuals who reported that they were neither 

overweight nor obese (43.7% in New York versus 40.0% 

nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to New York in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

New York Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

In 1999, cardiovascular disease (CVD) was the primary cause 

of death for all New Yorkers. Although CVD is a problem 

for all adults, in 1999 mortality was especially high for older 

age groups. However, disparities in CVD mortality are most 

obvious when examining rates of premature mortality (death 

before the age of 75); African Americans in New York in 1999 

were almost 30% more likely than whites to die prematurely 

from CVD and were 48% more likely to die specifically from 

stroke than their white counterparts. 

Many believe that CVD is a man’s disease, but a greater 

number of women die from CVD than men. This is partly 

explained by the large number of women in older age groups 

in New York where CVD deaths are concentrated. CDC heart 

disease mortality data from 1996 to 2000 indicate that the 

heart disease death rate for women in New York was 529 per 

100,000, compared with the rate for women in the United 

States, 438 per 100,000. These data also show that in 2001, 

heart disease was the leading cause of death for women age 65 

and over and was the second leading cause of death for women 

in the 45 to 54 age group and the 55 to 64 age group.

Tobacco use, physical inactivity, poor nutrition, obesity, 

hypertension, high blood cholesterol, and diabetes are known 

and modifiable risk factors for CVD. According to 2003 data 

from CDC’s Behavioral Risk Factor Surveillance System, the 

overall rate of adult smokers in New York was 22%. Almost 

one third of New York’s adult population was estimated to 

be physically inactive, 74.2% were consuming fewer than 5 

servings of fruits and vegetables a day, 20.9% were obese, and 

7.4% were reported to have diabetes. In 2003, 25.3% of the 

state’s adult population had high blood pressure, and 34.9% 

had high blood cholesterol. African Americans, those in lowerincome populations, and those with lower levels of education 

tended to have higher rates of smoking, physical inactivity, 

high blood pressure, obesity, and diabetes. 

Hospital expenditure data provide an indication of the direct 

costs of CVD in New York State. CVD hospitalization costs 

in 2000 were in excess of $6.8 billion. Sixty-one percent of 

these costs were for people under age 75. Seventy-five percent 

of all CVD hospitalizations were paid for with public funds. 

Direct and indirect expenditures for CVD in New York were 

estimated to be approximately $16 billion in 2002. 

Text adapted from The Burden of Cardiovascular Disease in New York: Mortality, 

Prevalence, Risk Factors, Costs, and Selected Populations (no date). 

Disparities in Health

Over one third of New York’s population is composed of racial 

and ethnic minorities, predominantly African Americans (15.9%) 

and Hispanics (15.1%). Health disparities among these 

populations are evident in many risk factors, in behavioral 

factors, and in certain mortality rates.

In 2000, Hispanics in New York tended to have a lower death 

rate for cancer (179.3 for men and 105.0 for women per 

100,000) than whites (235.8 per 100,000 for men and 169.0 

per 100,000 for women). From 1996 to 2000, Hispanics also 

tended to have lower death rates for heart disease (397 per 

100,000) and stroke (54 per 100,000) than whites (627 per 

100,000 for heart disease and 87 per 100,000 for stroke). 

Despite these lower death rates, Hispanics still have higher 

rates for many of the risk factors for these diseases. According 

to 2003 data from CDC’s Behavioral Risk Factor Surveillance 

System, Hispanics were less likely to consume 5 servings of 

fruits and vegetables per day than whites (22.4% versus 26.1%) 

and were less likely to meet the recommended guidelines for 

moderate physical activity than whites (34.8% versus 49.8%). 

When compared with whites, Hispanics also were more likely 

to be overweight (36.1%, compared with 34.9% of whites) or 

obese (22.2%, compared with 20.1% of whites). 

In New York, not only do African Americans have higher rates 

of various risk factors than Hispanics, but they also have higher 

rates of cancer, heart disease, and stroke deaths. In comparison 

with whites, African Americans were more likely to be 

overweight (37.5%, compared with 34.9% of whites) or obese 

(29.9%, compared with 20.1% of whites). African Americans 

were also more likely to have been told they have high blood 

pressure (33.0%) than whites (26.0%) and less likely to meet 

the recommended guidelines for moderate physical activity 

(34.4%) than their white counterparts (49.8%). 

Other Disparities

 Cervical Cancer: Although in 2002 African American 

women in New York were more likely to report having 

had a Pap smear in the last 3 years (12.7%, compared 

with 15.8% for white women), from 1997 to 2000 African 

American women had higher cervical cancer death rates 

(5.2 per 100,000) than white women (3.2 per 100,000).

 Prostate Cancer: In 2000, African American men had 

prostate cancer death rates more than twice that of white 

men (61.2 per 100,000 for African American men versus 

27.2 per 100,000 for white men).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Ohio

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Ohio

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Ohio, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Ohio

Estimated Cancer Deaths, 2004 

Cause of death US OH

All Cancers 563,700 24,480

Breast (female) 40,110 1,870

Colorectal 56,730 2,610

Lung and Bronchus 160,440 7,130

Prostate 29,900 1,120

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US OH

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US OH

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 24,480 are expected in 

Ohio. About 1.4 million new cases of cancer will be diagnosed 

nationally in 2004 alone. This figure includes 59,410 new cases 

that are likely to be diagnosed in Ohio. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Ohio, accounting for 

32,453 deaths or approximately 30% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 6,891 deaths 

or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Ohio

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Ohio BRFSS

 $216,594 

National Program of Cancer Registries 

 Ohio Cancer Incidence Surveillance System

 $1,358,521 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Great Lakes Stroke Regional Network

 Ohio Cardiovascular Health Alliance

 $356,165 

Diabetes Control Program 

 Diabetes Prevention and Education Program

 $708,668 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Project

 $4,363,333 

National Comprehensive Cancer Control Program 

 Ohio Cancer Program

 $300,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Ohio Tobacco Prevention and Control Program

 $1,395,373 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $8,698,654 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Ohio, FY 2003 

Ohio’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Ohio that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Ohio’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

African American men (404.4 per 100,000 in 1990 versus 

379.1 per 100,000 in 2000). 

 A 22.2% decrease in the number of women in Ohio older 

than age 50 who reported not having a mammogram in the 

last 2 years (from 42.8% in 1992 to 20.6% in 2002).

 Lower prevalence rates than the corresponding national 

rates of self-reported weight classification as overweight 

(35.8% in Ohio versus 37.0% nationally), and for Hispanic 

women older than age 18 who reported not having had a 

Pap smear in the last 3 years (8.1% for Hispanic women in 

Ohio versus 17.3% for Hispanic women nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Ohio in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Ohio Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD), which includes heart disease 

and stroke, is the nation’s leading killer among both men and 

women and affects all racial and ethnic groups. In 2001, CVD 

was the number one cause of death in Ohio, particularly for 

people aged 65 and older; however, it is the second leading 

cause of death among people aged 35 to 64. Both heart disease 

and stroke account for more deaths in every Ohio county than 

any other cause of death, including cancer.

In 2001, CDC mortality data indicate that the heart disease 

death rate in Ohio was the 13th highest in the United States 

and exceeded the national heart disease death rate by almost 

10% (271 per 100,000 versus 246.8 per 100,000 nationally). 

Although the stroke rate in Ohio is close to the national 

average (57.4 per 100,000 in Ohio compared with 57.5 

nationally), stroke still ranked as the third leading cause of 

death in 2001, according to CDC mortality data. 

In the 1990s, CVD death rates declined for both African 

Americans and whites in Ohio, but the gap between the two 

groups did not narrow. From 1990 to 1998, overall CVD death 

rates in the state declined 17.2% among white men and 10.2% 

among white women, but decreased only about 8.7% among 

African American men and 8.4% among African American 

women.

Modifiable risk factors for CVD include obesity, cigarette 

smoking, high blood pressure, high blood cholesterol, and 

diabetes. Adults in Ohio have higher rates of each of these risk 

factors than the corresponding national average. Data from 

CDC’s Behavioral Risk Factor Surveillance System indicate 

that in 2003, 24.9% of adults in Ohio were obese, compared 

with 22.8% nationally. In addition, 25.2% of adults in Ohio 

smoked, compared with 22.0% of adults nationally. Over 26% 

of adults in Ohio reported having been told that they have 

high blood pressure, compared with 24.8% nationally, and 

33.9% reported having been told that they have high blood 

cholesterol, compared with 33.1% nationally. Diabetes is a 

chronic disease; however, it is also a risk factor for CVD. In 

Ohio, 8.9% of adults reported having been told that they have 

diabetes, compared with 7.1% nationally. In 1999, 95% of 

adults reported having at least one risk factor for CVD and 

almost 80% reported having two or more CVD risk factors. 

Text adapted from Cardiovascular Disease in Ohio 2001: A Profile of 

Cardiovascular Disease Mortality and Related Behavioral Risk Factors.

Disparities in Health

Almost 20% of the US population lives in rural areas. People 

in these rural areas have a higher risk of heart disease, 

diabetes, and cancer, attributable in part to a population that 

is older, poorer, and less educated. More than one half of 

Ohio’s 88 counties are considered rural, and approximately 

2,807,706 people (26%) live in these areas. The majority of this 

population lives in the Appalachian region, which includes 

a 29-county area located in southeast Ohio. 

Appalachia has the third highest overall death rate in the United 

States (25% of these deaths could have been prevented by the 

adoption of healthier lifestyles). The Appalachian population 

also has high rates of risk factors; people living in this region 

are the most inactive population in the United States and 

have the ninth highest obesity rate in the nation. The rate of 

cigarette smoking among the Appalachian population is 29% 

(the national rate is 25%). Appalachia also has the highest lung 

cancer death rate in the nation and the second highest cervical 

cancer death rate in the United States. 

Heart disease death rates for Appalachian whites aged 35 to 64 

were consistently higher than those for the entire United States. 

In 1993, heart disease death rates for Appalachian white men 

aged 35 to 64 were 19% higher than the national rates for white 

men of all ages. Similarly, in 1993, heart disease death rates for 

Appalachian white women aged 35-64 were 21% higher than 

the national rates for white women of all ages.

Other Disparities

 Obesity: African Americans in Ohio are more likely to be 

obese (36.4%) than whites (24.0%).

 Physical Activity and Nutrition: Hispanics (54.6%) and 

African Americans (57.0%) are more likely to report not 

meeting the recommended guidelines for moderate physical 

activity than whites (52.5%); however, African Americans 

(24.0%) are more likely to report consuming 5 or more 

servings of fruits and vegetables per day than whites 

(22.0%) or Hispanics (19.4%).

 Cervical Cancer: Although data from CDC’s 2002 

Behavioral Risk Factor Surveillance System indicate that 

African American women were more likely to report having 

had a Pap smear in the last 3 years (94.6%) than white 

women (87.3%), African American women had cervical 

cancer death rates in 2001 almost twice as high as white 

women (5.0 per 100,000, compared with 2.6 per 100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Oklahoma

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Oklahoma

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Oklahoma, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Oklahoma

Estimated Cancer Deaths, 2004 

Cause of death US OK

All Cancers 563,700 7,640

Breast (female) 40,110 540

Colorectal 56,730 800

Lung and Bronchus 160,440 2,370

Prostate 29,900 340

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US OK

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US OK

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 7,640 are expected 

in Oklahoma. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 18,540 

new cases that are likely to be diagnosed in Oklahoma. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Oklahoma, accounting 

for 10,840 deaths or approximately 31% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,384 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Oklahoma

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Oklahoma BRFSS

 $141,259 

National Program of Cancer Registries 

 Oklahoma Central Cancer Registry

 $296,739 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Worksite Risk Reduction and Disease Management Pilot Project

 $300,000

Diabetes Control Program 

 Diabetes Control and Prevention Program

 $248,580 

National Breast and Cervical Cancer Early Detection Program 

 Oklahoma’s Breast and Cervical Cancer Early Detection Program

 $1,546,000 

National Comprehensive Cancer Control Program

 Oklahoma Comprehensive Cancer Control Program

 $129,118 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 Oklahoma Tobacco Prevention and Control Program

 $1,408,160 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 Association of American Indian Physicians

 Oklahoma State Department of Health

 The Choctaw Nation of Oklahoma

 $283,725 

 $905,008 

 $270,285 

Total $5,528,874 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Oklahoma, FY 2003 

Oklahoma’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Oklahoma that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Oklahoma’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among white men (278.7 per 100,000 in 1990 versus 263.5 

per 100,000 in 2000).

 A 16.7% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 45.3% in 1992 to 28.6% in 2002). 

 A lower mortality rate than the corresponding national rate 

for female breast cancer among women of all races (25.6% 

in Oklahoma versus 26.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Oklahoma in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Oklahoma Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD), primarily heart disease and 

stroke, are the nation’s leading causes of death among both men 

and women of all racial and ethnic groups. 

2001 CDC mortality data indicate that Oklahoma had the third 

highest heart disease death rate and the 10th highest stroke death 

rate in the nation. From 1996 to 2000, Oklahoma had heart 

disease death rates that were higher than the national average 

(629 per 100,000 versus 536 per 100,000). Oklahoma also had 

higher stroke death rates than the national average (131 per 

100,000 versus 121 per 100,000).

CVD is easily prevented by modifying behavioral risk factors 

such as nutrition, high blood pressure, physical inactivity, and 

smoking. Oklahoma’s residents, however, have high rates for 

all of these risk factors. According to 2003 data from CDC’s 

Behavioral Risk Factor Surveillance System, only 15.4% of 

Oklahomans reported consuming 5 or more servings of fruits 

and vegetables per day, compared to 22.5% nationally. Almost 

60% of people in the state did not meet the recommended 

guidelines for moderate physical activity, compared to 52.5% 

nationally, and the percentage of smokers in Oklahoma was 

higher than the national rate (25.1% versus 22.0%). In addition, 

28.0% of Oklahomans reported having been told that they had 

high blood pressure, compared to the national rate of 24.8%. 

Disparities also exist for CVD death rates among racial and 

ethnic minorities and women. African Americans in Oklahoma 

have the highest heart disease and stroke rates (741 per 100,000 

and 165 per 100,000, respectively); these rates are also higher 

than the national death rates for these diseases among African 

Americans (662 per 100,000 for heart disease and 166 per 

100,000 for stroke). Women in Oklahoma also have higher than 

average CVD death rates, with heart disease death rates of 513 

per 100,000 (versus 438 per 100,000 nationally) and stroke death 

rates of 128 per 100,000 (versus 117 per 100,000 nationally).

The Oklahoma State Department of Health began receiving funds 

from CDC in 2000 to support a state heart disease and stroke 

prevention program, the Oklahoma Heart Disease and Stroke 

Health Program. One of the program’s achievements has been 

to provide funding to rural communities to purchase automated 

external defibrillators (AEDs) and to train potential users. The 

program is also addressing health systems improvements for 

stroke and heart attack response and care in selected rural areas. 

Text adapted from Cardiovascular Disease in Oklahoma: An Overview (2001).

Disparities in Health

Across the country, American Indians and Alaska Natives 

(AI/ANs) comprise more than 500 federally recognized tribes 

and represent 1% of the U.S. population. Compared with other 

racial and ethnic minorities, AI/ANs have the highest poverty 

rate, 26%, which is 2 times the national rate. In addition to 

high poverty levels, AI/ANs are experiencing growing health 

disparities. Much of the data on health disparities among the 

AI/AN population are from the Indian Health Service (IHS). 

The Oklahoma IHS office is the agency’s largest regional office 

and provides health care to over 281,000 AI/ANs throughout 

Oklahoma, northeastern Kansas, and Eagle Pass, Texas.

Preventable diseases—heart disease, cancer, accidents, 

diabetes, and cerebrovascular diseases—are the leading causes 

of death among AI/ANs in the IHS Oklahoma area. These 

diseases accounted for the top five causes of death among

AI/ANs between 1994 and 1996. Heart disease represented 

almost 30% of these deaths. From 1996 to 2000, heart disease 

death rates among AI/ANs in Oklahoma were above the 

national average (402 per 100,000 versus 352 per 100,000). 

Cancer accounted for nearly 20% of the deaths in the 

Oklahoma area during the same period. 

Throughout the nation, IHS data indicate that diabetes is the 

second leading cause of outpatient visits and the eighth leading 

cause of death. In the Oklahoma City area, from 1994 to 1996, 

IHS data indicate that diabetes was the 5th leading cause of 

death for AI/ANs, with a mortality rate of 24.6 per 1,000 and 

accounted for approximately 6% of all deaths among AI/ANs.

Other Disparities

 Breast Cancer: The percentage of African American 

women in Oklahoma who have not had a mammogram in 

the last 2 years (32.0%) is higher than the percentage for 

white women (28.9%), and more African American women 

die from breast cancer (35 per 100,000) than white women 

(25.8 per 100,000). 

 Obesity: Hispanics and African Americans in Oklahoma 

are more likely to be obese than whites: 32.6% of Hispanics 

are obese compared with 28.3% of African Americans, and 

22.6% of whites.

 High Blood Pressure: African Americans in Oklahoma are 

more likely to report having been told that they have high 

blood pressure than whites (34.2% of African Americans 

have high blood pressure, compared with 28.5% of whites).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Oregon

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Oregon

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Oregon, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Oregon

Estimated Cancer Deaths, 2004 

Cause of death US OR

All Cancers 563,700 7,120

Breast (female) 40,110 510

Colorectal 56,730 690

Lung and Bronchus 160,440 1,980

Prostate 29,900 380

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US OR

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US OR

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 7,120 are expected 

in Oregon. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 17,280 

new cases that are likely to be diagnosed in Oregon. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Oregon, accounting 

for 7,075 deaths or approximately 23% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 2,558 deaths 

or approximately 9% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Oregon

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Oregon BRFSS

 $257,723 

National Program of Cancer Registries 

 Oregon State Cancer Registry

 $782,347 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Providence St. Vincent Medical Center (Paul Coverdell Stroke Registry)

 $299,919

 $699,031 

Diabetes Control Program 

 Oregon Diabetes Control and Prevention Program

 $809,770 

National Breast and Cervical Cancer Early Detection Program 

 Oregon Breast and Cervical Cancer Program

 $3,407,028 

National Comprehensive Cancer Control Program

Health Promotion and Chronic Disease Prevention Program 

 $135,317 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Oregon Tobacco Prevention and Control Program

 $1,408,160 

State Nutrition and Physical Activity/Obesity Prevention Program

 Shape Up Across Oregon

 Walk to School Day

 $449,471 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 African American Health Coalition, Inc.

 $903,920 

Total $9,152,686 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Oregon, FY 2003 

Oregon’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Oregon that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Oregon’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, from 274.0 per 100,000 in 1990 to 

265.9 per 100,000 in 2000. 

 An 11.8% decrease in the number of women older than age 

50 who reported not having a mammogram in the last 2 

years (from 30.6% in 1992 to 18.8% in 2002). 

 A higher prevalence rate than the corresponding national 

rate for individuals who reported that they were neither 

overweight nor obese (41.7% in Oregon versus 40.0% 

nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Oregon in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Oregon Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease 

In 2001, cardiovascular disease (CVD) was the leading 

cause of death in Oregon, accounting for over one third of all 

deaths. CVD is also a major cause of costly hospitalization 

and disability. In 2001, there were 50,423 CVD-related 

hospitalizations in the Oregon; of these hospitalizations, 

34,306 were for heart disease and 8,676 were for stroke. These 

hospitalizations resulted in hospital charges of $652 million 

(approximately $549 million for heart disease and $103 

million for stroke). The average charge for a CVD-associated 

hospitalization was $15,500; heart disease hospitalizations 

averaged $15,888, and the average stroke-associated 

hospitalization was $11,851. 

In 2001, the age-adjusted death rates for CVD in Oregon were 

42% higher for men (350.5 per 100,000) than women (249.5 

per 100,000), but in absolute numbers, more deaths occurred 

among women (5,592) than among men (5,031). In addition, 

in Oregon, premature deaths (deaths that occurred in persons 

younger than age 65) from heart disease were highest among 

men (21%, compared with 9% for women). Premature deaths 

from stroke were also highest among men (11%, compared 

with 6% for women). In addition to the gender disparity in 

the risk associated with CVD death rates, there is also a racial 

disparity. African Americans in Oregon have the highest risk 

for death due to heart disease and stroke; from 1996 to 2000, 

African Americans in the state had a heart disease death rate 

of 495 per 100,000, compared with 421 per 100,000 for their 

white counterparts, although this death rate was lower than the 

national heart disease death rate for African Americans (662 

per 100,000). From 1991 to 1998, the stroke death rate for 

African Americans was higher than the rate for whites (209 per 

100,000 for African Americans compared with 145 per 100,000 

for whites). Unlike heart disease, African Americans in Oregon 

had a higher stroke death rate than the national stroke death 

rate for African Americans (209 per 100,000 versus 166 per 

100,000).

In 2003, Oregon launched its Heart Disease & Stroke 

Prevention Program, which is funded through a cooperative 

agreement with the Centers for Disease Control and 

Prevention. The purpose of the program is to improve 

cardiovascular health statewide through changes in both the 

policy and the community environments.

Text adapted from the Oregon Heart Disease and Stroke Report (2001). 

Disparities in Health

People of Hispanic origin represent approximately 13% of the 

U.S. population. According to the 2000 Census, the Hispanic 

population, which increased by more than 50% from 1990 to 

2000, is the fastest growing ethnic group in the United States. 

Hispanics are Oregon’s largest minority population, making 

up approximately 8% of the state’s population. In addition 

to these residents, the state also has approximately 128,000 

migrant and seasonal farm workers. 

Compared with other racial and ethnic groups across the 

state, Hispanics in Oregon have the lowest death rates for 

heart disease and stroke. From 1996 to 2000, the heart 

disease death rate for Hispanics in Oregon was 190 per 

100,000, compared with 421 per 100,000 for whites, 495 

per 100,000 for African Americans, 347 per 100,000 for 

American Indians/Alaska Natives and 239 per 100,000 for 

Asian/Pacific Islanders. From 1991 to 1998, the stroke death 

rate for Hispanics was 75 per 100,000, compared with 129 

per 100,000 for Asian/Pacific Islanders, 209 per 100,000 for 

African Americans, and 145 per 100,000 for whites. 

Although Hispanics have low rates of chronic disease 

compared with whites and other racial and ethnic minorities, 

they have high rates of risk factors for chronic diseases, such 

as inactivity, poor nutrition and overweight. According to 

2003 data from CDC’s Behavioral Risk Factor Surveillance 

System, Hispanics in Oregon had high levels of physical 

inactivity (37.8%, compared with 16.4% of whites) and 

low fruit and vegetable consumption (80.9% of Hispanics 

consumed less than 5 fruits and vegetables per day, compared 

with 75.7% of whites). Oregon’s Hispanics also reported 

high levels of overweight; in 2003, 42.9% of Hispanics were 

overweight, compared with 36.2% of whites.

Other Disparities

 Breast Cancer: Although the incidence of breast cancer 

among African American women was lower than among 

white women in Oregon from 1998 to 2000 (125.2 per 

100,000, compared with 147.8 per 100,000), African 

American women had a higher breast cancer death rate in 

2000 (32.2 per 100,000, compared with 26.4 per 100,000).

 Prostate Cancer: In Oregon between 1997 and 2001, 

African American men had a higher prostate cancer death 

rate than white men (56.7 per 100,000 compared with 32.5 

per 100,000). 
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Pennsylvania

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Pennsylvania

350

400

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Pennsylvania, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Pennsylvania

Estimated Cancer Deaths, 2004 

Cause of death US PA

All Cancers 563,700 29,910

Breast (female) 40,110 2,080

Colorectal 56,730 3,310

Lung and Bronchus 160,440 7,900

Prostate 29,900 1,560

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US PA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US PA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 29,910 are expected 

in Pennsylvania. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 72,590 

new cases that are likely to be diagnosed in Pennsylvania. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Pennsylvania, accounting 

for 38,291 deaths or approximately 30% of the state’s deaths 

in 2002 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 8,442 

deaths or approximately 7% of the state’s deaths in 2002. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Pennsylvania

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Pennsylvania BRFSS

 $97,342 

National Program of Cancer Registries 

 Pennsylvania Cancer Registry

 $431,689 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 The Taking Control Program 

 Living Well With Diabetes

 $557,967 

National Breast and Cervical Cancer Early Detection Program 

 Healthy Woman Project

 $2,020,290 

National Comprehensive Cancer Control Program 

 Pennsylvania Cancer Control Program

 $149,722 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 Pennsylvania Tobacco Prevention and Control Program

 $1,087,980 

State Nutrition and Physical Activity/Obesity Prevention Program

 Governor’s Keystone Ride

 Great Pennsylvania Workout 

 Keystone Athletes Mentoring Pennsylvanians (KAMP)

 Keystone State Games, Inc.

 KidsWalk to School

 Pennsylvania Senior Games

 OPANAC - Osteoporosis, Physical Activity, Nutrition and Cardiovascular Programs

 Safe Routes to School/Walking School Bus 

 $649,262 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $4,994,252 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Pennsylvania, FY 2003 

Pennsylvania’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Pennsylvania that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Pennsylvania’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among African American men (433.9 per 100,000 

in 1990 versus 365.8 per 100,000 in 2000). 

 A 17.1% decrease in the number of women older than age 

50 who reported not having a mammogram in the last 2 

years (from 38.2% in 1992 to 21.1% in 2002). 

 A lower prevalence rate than the corresponding national 

rate for Hispanic women older than age 18 who reported 

not having had a Pap smear in the last 3 years (16.0% in 

Pennsylvania versus 17.3% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Pennsylvania in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Pennsylvania Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: 

Cardiovascular Disease 

Cardiovascular disease (CVD), including heart disease and 

stroke, is the leading cause of death in Pennsylvania, accounting 

for about 34% of all deaths in the state. From 1996 to 2001, 

the state’s heart disease death rate was 567 per 100,000, which 

was higher than the national rate of 536 per 100,000. The stroke 

death rate, however, was lower than the national rate. From 1991 

to 1998 the stroke rate in Pennsylvania was 116 per 100,000, 

compared with the national rate of 121 per 100,000.

Risk factors for CVD include poor nutrition, physical inactivity, 

overweight and obesity, and high blood pressure. Data from 

CDC’s Behavioral Risk Factor Surveillance System (BRFSS) 

indicate that in 2003 only one quarter (24.7%) of adults in 

Pennsylvania reported consuming 5 or more servings of fruits 

and vegetables per day. In addition, 22.6% did not participate 

in any leisure time physical activity during the past month. As 

a result of these behaviors, approximately 60% of Pennsylvania 

adults were overweight (36.3%) or obese (23.8%). Over one 

quarter (26.5%) of adults in Pennsylvania reported having been 

told that they have high blood pressure.

Diabetes also is a risk factor for CVD and is the sixth leading 

cause of death in Pennsylvania. CDC mortality data from 

2001 indicate that the diabetes death rate in the state (25.7 per 

100,000) was higher than the national diabetes death rate (25.2 

per 100,000). In 2003, 8.0% of Pennsylvanians reported having 

been told by a doctor that they have diabetes, compared with the 

national rate of 7.1%. 

In order to address the risk factors associated with heart 

disease and stroke, the Pennsylvania Nutrition and Physical 

Activity Plan (PaNPA Plan) was developed by the Pennsylvania 

Department of Health and its stakeholders. Pennsylvania 

Advocates for Nutrition and Activity is funded by the 

Department of Health to improve nutrition and physical activity 

statewide through policy and environment interventions. The 

mission of the PaNPA Plan is to create a Pennsylvania where 

individuals, communities and public and private entities share 

the responsibility for developing an environment to support and 

promote active lifestyles and access to healthy food choices. The 

plan presents strategies and activities necessary for communitybased interventions to increase healthy eating and physical 

activity opportunities. 

Text adapted from State Health Improvement Plan Special Report on the 

Health Status of Minorities in Pennsylvania (2002).

Disparities in Health 

African Americans, who comprise approximately 12% of the 

U.S. population—roughly 35 million people—experience 

disproportionate health disparities. They have higher stroke 

death rates than other groups as well as a higher prevalence 

of the risk factors for chronic diseases. They suffer higher 

death rates for cancer and heart disease as well. In addition, 

approximately 2.7 million African Americans in the United 

States have diabetes; however, one third of them do not know 

it. African American communities throughout the United States 

experience hardships due to these health disparities.

In Pennsylvania, African Americans constitute about 9% of the 

state’s population. Heart disease is the leading cause of death 

among African Americans in the state. The heart disease death 

rate for African Americans in Pennsylvania is 298.5 per 100,000; 

the rate for their white counterparts is 255.1 per 100,000. 

According to CDC’s 2003 Behavioral Risk Factor Surveillance 

(BRFSS) data, African Americans also had higher prevalence 

rates for high blood pressure than whites or Hispanics in the 

state (33.1% of African Americans in Pennsylvania reported 

having been told they had high blood pressure versus 26.1% of 

whites and 24.2% of Hispanics). 

Data from the 2003 BRFSS also indicate that in Pennsylvania, 

the rate of overweight and obesity was highest among African 

Americans (76.4%). The rate of obesity (based on body mass 

index) for African Americans was 35.1%, compared with the 

rate for whites, 23.1%. The rate of obesity among African 

Americans in Pennsylvania also was higher than the rate 

of obesity among African Americans in the United States 

(32.6%). African Americans in Pennsylvania were less likely to 

participate in regular leisure time physical activity (71.7%) than 

whites (78.6%). 

Approximately 14% of African Americans in Pennsylvania 

were diagnosed with diabetes in 2003, in comparison to 7.6% of 

whites. The diabetes death rate in 2002 for African Americans 

in the state (42.0 per 100,000) was also significantly higher than 

the rate for whites (24.5 per 100,000). 

Other Disparities

 Stroke: In Pennsylvania from 1991 to 1998, the stroke death 

rate for African Americans was 74.7 per 100,000, compared 

with the rate for whites, 54 per 100,000.

 Smoking: African Americans (35.4%) and Hispanics 

(33.4%) are more likely to be smokers than whites (23.9%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Rhode Island

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Rhode Island

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Rhode Island, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Rhode Island

Estimated Cancer Deaths, 2004 

Cause of death US RI

All Cancers 563,700 2,450

Breast (female) 40,110 160

Colorectal 56,730 250

Lung and Bronchus 160,440 700

Prostate 29,900 130

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US RI

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US RI

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 2,450 are expected 

in Rhode Island. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 5,950 

new cases that are likely to be diagnosed in Rhode Island. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death of death in Rhode Island, 

accounting for 3,076 deaths or approximately 31% of the 

state’s deaths in 2001 (the most recent year for which data are 

available). Stroke is the third leading cause of death, accounting for 614 deaths or approximately 6% of the state’s deaths 

in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. A key 

strategy for addressing these risk factors is to educate the public 

and health care practitioners about the importance of prevention. 

All people should also partner with their health care providers to 

have their risk factor status assessed, monitored, and managed 

in accordance with national guidelines. People should also be 

educated about the signs and symptoms of heart attack and 

stroke and the importance of calling 911 quickly. Forty-seven 

percent of heart attack victims and about the same percentage of 

stroke victims die before emergency medical personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Rhode Island

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Rhode Island BRFSS

 $169,925 

National Program of Cancer Registries 

 Rhode Island Cancer Registry

 $303,833 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Diabetes Resource Center (DRC)

 Diabetes Outpatient Education (DOE) Board and DOE Educators 

 Statewide “Eureka” Initiative

 Rhode Island Cooperative Eye Care Project

 Diabetes Multicultural Coalition (DMC) 

 Teamworks 

 Diabetes Community Health Improvement Project (Diabetes CHIP)

 $787,398 

National Breast and Cervical Cancer Early Detection Program 

 Women’s Cancer Screening Program

 $1,528,829 

National Comprehensive Cancer Control Program 

 Comprehensive Cancer Control

 Rhode Island Cancer Control Plan

 $194,525 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Rhode Island Tobacco Prevention and Control Program

 $1,179,875 

State Nutrition and Physical Activity/Obesity Prevention Program $88,060 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $4,252,445 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Rhode Island, FY 2003 

Rhode Island’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Rhode Island that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Rhode Island’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among African American men (474.1 per 100,000 

in 1990 versus 365.4 per 100,000 in 2000). 

 A 19.7% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 31.6% in 1992 to 11.9% in 2002). 

 Lower prevalence rates than the corresponding national 

rates for self-reported obesity (18.4% in Rhode Island 

versus 22.8% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Rhode Island in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Rhode Island Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Obesity and Overweight

Overweight and obesity have reached epidemic proportions 

in the United States. Obesity-related health problems and 

associated costs are soon expected to surpass those associated 

with tobacco. Obesity rates among adults have steadily 

increased for all states including Rhode Island, where the 

obesity rate has almost doubled in the past 10 years. Rhode 

Island’s Hispanics have experienced the sharpest relative 

increase in overweight and obesity (from 48% between 1991 

and 1994 to 61% between 1998 and 2000). Over this same 

period, the prevalence of overweight and obesity remained 

highest among the state’s African American adults. 

Data from CDC’s Behavioral Risk Factor Surveillance 

System (BRFSS) indicate that in 2003, 38.5% of Rhode 

Island’s population were overweight and an additional 18.4% 

were obese. The percentage of Rhode Island men who were 

overweight (48.1%) was higher than that of Rhode Island 

women (29.5%). The percentage of overweight whites in 

the state (39.3%) is slightly higher than the percentages 

for Hispanics (39.0%) and African Americans (37.9%). 

Several factors cause overweight and obesity: food and 

nutrient consumption patterns, a lack of physical activity, and 

socioeconomic factors. In Rhode Island, approximately 73% 

of the population consumes less than 5 servings of fruits and 

vegetables per day. In 2003, 23.3% of Rhode Islanders reported 

having no leisure time physical activity and almost 50% 

reported not meeting recommended guidelines for moderate 

physical activity.

Although overweight and obesity are problems on their own, 

they are also risk factors for diabetes. In 2002, 49,000 adult 

Rhode Islanders were diagnosed with diabetes or 5.8 per 100. 

The overall death rate in 2001 due to diabetes was 21.7 per 

100,000. In Rhode Island, diabetes also seems to affect men 

more than women. The death rate for diabetes was higher 

among men (25.2 per 100,000) in Rhode Island than women 

(19.3 per 100,000). 

In order to help combat the obesity problem in Rhode Island, 

the Rhode Island Department of Health is working with state 

and community partners on a 3-year obesity prevention and 

control program, “Initiative for a Healthy Weight.” 

Text adapted from Rhode Island Obesity Control Program: A Public Health

Approach to Addressing Overweight and Obesity Among Children and Adults, 2002.

Disparities in Health

Hispanics represent approximately 13% of the U.S. population. 

According to the 2000 Census, this population, which increased 

by more than 50% from 1990 to 2000, is the fastest growing 

ethnic group in the United States. The greatest concentration of 

Hispanic populations is in the southwestern states. Hispanics 

make up nearly 9% of the population in Rhode Island, a 

percentage that is almost double that of the state’s Hispanic

population in 1990. In 2001, the poverty rate for Hispanics in 

Rhode Island was 43%, more than twice the rate for African 

Americans (20%) and 4 times the rate for whites in the state 

(10%). In 2003, 35.0% of Hispanics in Rhode Island had 

less than a high school diploma and 14.2% had a college 

degree. Approximately 63.0% of the Hispanic population in 

the state has an annual income of less than $25,000. These 

socioeconomic factors contribute to the health disparities 

prevalent among Hispanics in Rhode Island. 

Data from the Behavioral Risk Factor Surveillance System 

indicate that in 2003 Hispanics in Rhode Island had a higher 

rate of obesity (20.9%) than whites (18.4%). Hispanics are 

also at greater risk of developing health problems related 

to being overweight (59.9%) than whites (57.7%). BRFSS 

data from 2003 show that Hispanic Rhode Islanders had 

higher prevalence rates of diabetes (11.2%) than their African 

American (6.8%) and white (6.5%) counterparts. In addition, 

67% of Hispanics in Rhode Island reported not meeting 

recommended guidelines for moderate physical activity. This 

percentage is higher than the percentage of whites in Rhode 

Island who report not meeting recommended guidelines for 

moderate physical activity (47.5%). 

Other Disparities

 Breast Cancer Screening: In 2002, only 50% of Hispanic 

women in Rhode Island reported ever having had a 

mammogram, compared with 70% of white women. 

 Colorectal Cancer Screening: In 2002, 56% of Hispanic 

men in Rhode Island reported never having had a 

sigmoidoscopy or colonoscopy, compared with 45% of 

white men. 

 Cholesterol Screening: In Rhode Island, 31.0% of 

Hispanics reported never having had their blood cholesterol 

checked; in contrast, only 12.2% of whites reported never 

having had their blood cholesterol checked.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

South Carolina

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States South Carolina

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and South Carolina, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States South Carolina

Estimated Cancer Deaths, 2004 

Cause of death US SC

All Cancers 563,700 8,860

Breast (female) 40,110 610

Colorectal 56,730 880

Lung and Bronchus 160,440 2,720

Prostate 29,900 620

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US SC

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US SC

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 8,860 are expected in 

South Carolina. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 21,500 

new cases that are likely to be diagnosed in South Carolina. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in South Carolina, accounting for 9,471 deaths or approximately 26% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 2,832 

deaths or approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States South Carolina

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 South Carolina BRFSS

 $203,056 

National Program of Cancer Registries 

 South Carolina Central Cancer Registry

 $903,768 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Tri-State Stroke Network

 $1,100,000 

Diabetes Control Program 

 South Carolina Diabetes Prevention and Control Program

 $750,035 

National Breast and Cervical Cancer Early Detection Program 

 Division of Cancer Prevention and Control

 $3,312,674 

National Comprehensive Cancer Control Program 

 Division of Cancer Prevention and Control

 $150,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 South Carolina Tobacco Prevention and Control Program

 $1,189,479 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Award Program

 Discover and Understand Carolina, Kids (DUCK) Walking Program

 Heart Smart

 It’s Everywhere You Go!

 Walk Our Children to School Day

 $367,372 

Racial and Ethnic Approaches to Community Health (REACH 2010) 

 Medical University of South Carolina 

 $1,017,488 

Total $8,993,872

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for South Carolina, FY 2003 

South Carolina’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in South Carolina that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of South Carolina’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among men 

across all races, with the greatest decrease occurring among 

African Americans (424.5 per 100,000 in 1990 versus 375.7 

per 100,000 in 2000). 

 A 19.2% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 39.5% in 1992 to 20.3% in 2002). 

 Lower prevalence rates than the corresponding national rates 

for women older than age 18 who reported not having had a 

Pap smear in the last 3 years (15.1% in South Carolina versus 

16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to South Carolina in 

the areas of cancer, heart disease, stroke, and related risk factors. 
4

South Carolina Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Cardiovascular Disease 

Cardiovascular disease (CVD) is the leading cause of death 

and disability in South Carolina. In 2001, CVD accounted for 

approximately 34% of deaths in South Carolina. Although 

known as a primary cause of death in older adults, it is also the 

leading cause of death of South Carolinians aged 35-44 and 

one of the top five causes of death in children (1-4 years) and 

young adults (15-24 years). Together, heart disease and stroke 

account for over 90% of all CVD deaths. 

According to the 2001 CDC mortality data, South Carolina had 

the 23rd highest heart disease death rate in the nation and the 

2nd highest stroke disease death rate. Due to these rankings 

and the geographic proximity of other states with high numbers 

of stroke deaths, South Carolina, North Carolina, and Georgia 

are known as the “stroke belt.” High stroke death rates in the 

Pee Dee and Coastal regions of South Carolina have earned 

this area the dubious distinction of being the “stroke buckle” 

of the “stroke belt.” The economic costs of CVD in South 

Carolina are staggering. In 1999, the cost of CVD in South 

Carolina was almost $1.4 billion in direct costs (hospital 

charges). Of these charges, $629 million (45%) was for 

coronary heart disease and $15 million (15%) was for stroke. 

The total hospital charges for treatment of cardiovascular 

disease patients increased by 330% from 1987 to 1999.

The state has adopted a comprehensive approach to reduce 

CVD deaths. One of the primary objectives of South Carolina 

Cardiovascular Health State Plan is to strengthen the 

state’s core capacity by focusing on promoting policy and 

environmental change in the areas of physical inactivity, 

poor nutrition, tobacco use, hypertension, and high blood 

cholesterol. Sites for primary intervention correspond to 

organizational and community-level needs such as school, 

worksites, and faith communities. Secondary prevention 

focuses on the health care system to ensure that screening, 

detection, and follow-up care include appropriate and 

standardized management of clinical risk factors for CVD. 

In design, the plan seeks to ensure that systemic remedies 

for CVD care and prevention are in place, available, and 

accessible to all South Carolinians, with emphasis on the 

priority populations—African Americans, the indigent and 

underserved, and residents in rural areas. 

Adapted from South Carolina Cardiovascular Health State Plan 2000-2007.

Disparities in Health

African Americans, who comprise over 30% of South Carolina’s 

population, have heart disease and stroke death rates that are 

approximately 11⁄2 to 2 times higher than the state’s white 

population. This difference is most prominent among African 

American women in South Carolina who, in 2000, were 1.3 

times more likely to die of heart disease than white women. 

Risk factors for heart disease and stroke include high blood 

pressure, poor nutrition, and lack of exercise. In South Carolina, 

African Americans are at a higher risk for these factors than 

whites. According to 2003 data from CDC’s Behavioral 

Risk Factor Surveillance System, over one third of African 

Americans report having been told they have high blood 

pressure (35.3%), compared with only one quarter of whites 

(26.7%). In addition, 63.3% of African Americans report not 

meeting the recommended guidelines for moderate physical 

activity, compared with 51.1% of whites, and only 19.8% of 

African Americans report consuming 5 or more servings of 

fruits and vegetables per day.

According to CDC’s 2000 cancer mortality data, African 

Americans also had higher death rates from cancer (375.7 per 

100,000 for men and 189 for women per 100,000) than whites 

(265.3 per 100,000 for men and 158.5 per 100,000 for women). 

Although African American women are more likely to report 

having had a mammogram in the last 2 years (82.9%, compared 

with 78.1% of white women), in 2000 they were more likely to 

die from breast cancer than their white counterparts (37.9 per 

100,000 African American women, compared with 25.6 per 

100,000 white women). Prostate cancer screening rates are not 

available for South Carolina, but in 2000 the state’s African 

American men had a prostate cancer death rate that was more 

than twice the rate for white men (81.1 per 100,000 compared to 

28.9 per 100,000).

Other Disparities

 Diabetes: African Americans (15.0%) and Hispanics (9.9%) 

are more likely to report having been told they have diabetes 

than whites (7.3%). South Carolina’s racial and ethnic groups 

are 3 times more likely to die from the disease than whites. 

 Obesity: South Carolina’s African Americans (36.9%) are 

more likely to be obese than whites (21.5%).

 Lung Cancer: In South Carolina in 2000, African American 

men (102.3 per 100,000) had a higher lung cancer death rate 

than white men (89.8 per 100,000).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: cdcinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

South Dakota

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States South Dakota

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and South Dakota, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States South Dakota

Estimated Cancer Deaths, 2004 

Cause of death US SD

All Cancers 563,700 1,650

Breast (female) 40,110 100

Colorectal 56,730 190

Lung and Bronchus 160,440 420

Prostate 29,900 120

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US SD

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US SD

+ Represents fewer than 50 deaths.

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 1,650 are expected 

in South Dakota. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 4,000 

new cases that are likely to be diagnosed in South Dakota. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in South Dakota, accounting for 1,985 deaths or approximately 29% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 490 

deaths or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States South Dakota

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 South Dakota BRFSS

 $92,721 

National Program of Cancer Registries

 South Dakota Cancer Registry

 $280,430 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Diabetes Education Recognition Program

 The Link Program 

 $300,000 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Program

 $819,322 

National Comprehensive Cancer Control Program $0 

WISEWOMAN

 A New Leaf...Choices for Healthy Living 

 Active Living Every Day

 $681,373 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 South Dakota Tobacco Prevention and Control Program 

 $793,593 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $2,967,439 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for South Dakota, FY 2003 

South Dakota’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in South Dakota that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of South Dakota’s Prevention 

Successes

 A diabetes death rate that is lower than the national average 

(24.2 per 100,000 versus 25.2 per 100,000). 

 An 18.4% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 38.7% in 1992 to 20.3% in 2002). 

 Prevalence rates lower than the corresponding national rates 

for self-reported high blood cholesterol (31.2% in South 

Dakota versus 33.1% nationally) and for women older than 

age 18 who reported not having had a Pap smear in the last 

3 years (15.9% in South Dakota versus 16.7% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to South Dakota in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

South Dakota Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Childhood Overweight

Childhood overweight is a risk factor for adult conditions such as 

obesity, cardiovascular disease, hypertension, diabetes, and other 

health problems. Research from a national study published in 

Pediatrics concluded that 60% of overweight 5- to 10-year olds 

already have at least one risk factor for heart disease. 

In South Dakota, childhood overweight is a growing problem. 

Data from the Height and Weight Report for South Dakota 

Students for school year 2002-2003 showed an increase in 

the numbers of elementary and middle school children aged 

12 and older who were at risk for overweight, and indicated 

slight decreases in the number of at-risk children aged 12 and 

younger. The data also showed that 16.2% of whites and 17.6% 

of American Indians/Alaska Natives (AI/ANs) were at risk for 

overweight (see table below). During the 2002-2003 school year, 

the numbers of children considered overweight increased in all 

age groups, with the exception of children aged 15 to 19. The 

data also provided evidence of racial disparities in the prevalence 

of childhood overweight: approximately 14.5% of whites and 

23.6% of AI/ANs were overweight. Compared with data from the 

2001-2002 school year, these figures represent a slight increase 

for whites (+0.2), but a noticeable increase for AI/ANs (+3.5%). 

South Dakota has developed several approaches to address 

the problem of childhood overweight. For example, the state 

is tracking the prevalence of the problem through its School 

Height and Weight Reports, and is working to coordinate obesity 

prevention efforts among parents, teachers and coaches, and 

school administrators. 

Text adapted from School Height and Weight Report for South Dakota Students, 

2002-2003 School Year (2003). 

Disparities in Health

The five leading causes of death in 1998 for all South Dakota 

residents were heart disease, cancer, cerebrovascular diseases, 

accidents, and chronic obstructive pulmonary diseases. Heart 

disease accounted for 31% of South Dakota’s deaths in 1998. 

Since 1980, women have accounted for over 40% of South 

Dakota’s heart disease deaths; since 1992, this death rate has 

been nearing 50%. The American Heart Association (AHA) 

reports that after menopause women are at greater risk for heart 

disease than men. The AHA also reports the controllable risk 

factors that can reduce the risk of heart disease for both men 

and women include avoiding tobacco, maintaining a low-fat 

diet, and engaging in regular physical activity.

AI/ANs, who comprise more than 500 federally recognized 

tribes across the country, represent 1% of the U.S. population. 

Compared with other racial and ethnic minorities, AI/ANs have 

the highest poverty rate, 26%, which is 2 times the national 

rate. Like AI/ANs in the United States, South Dakota’s AI/ANs 

are experiencing increasing health disparities. 

In South Dakota, AI/ANs represent the state’s largest minority 

population (7.3%). The leading causes of death for AI/ANs 

in South Dakota are heart disease, cancer, accidents, chronic 

liver disease, and diabetes. According to the Indian Health 

Service, approximately 25.4% of the adult population on South 

Dakota’s Indian reservations has been diagnosed with diabetes. 

American Indians in South Dakota have heart disease death 

rates that are considerably higher than the rates for whites (819 

per 100,000 versus 467 per 100,000). Stroke rates for South 

Dakota’s AI/ANs are also higher than the rates for whites (165 

per 100,000 versus 115 per 100,000).

To begin to address the issues of heart disease and diabetes, 

the South Dakota Department of Health has implemented both 

a Cardiovascular Health Program and a Diabetes Prevention 

and Control Program, working with populations throughout the 

state who are at risk for these diseases.

Other Disparities

 Smoking: Individuals who indicated that they were of 

“other race” were more likely to report being current 

smokers (37%) than whites (21.2%).

 Nutrition: Individuals who indicated that they were of 

“other race” were more likely to report not consuming 5 or 

more servings of fruits and vegetables per day (82.3%) than 

whites (80.9%).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Students at Risk for Overweight and Currently Overweight by Race, 

School Year 2002-2003

Race

Total

White AI/ANs Other 

Races

Race 

Unknown

Number of Students 14,005 2,785 581 1,991 19,362

At Risk for Overweight 16.2% 17.6% 20.5% 17.2% 16.7%

Currently Overweight 14.5% 23.6% 17.9% 20.4% 16.6%

At Risk for Overweight 

and Currently 

Overweight Combined

30.7% 41.2% 38.4% 37.6% 33.3%

Source: South Dakota Department of Health
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Tennessee

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States Tennessee

350

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Tennessee, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Tennessee

Estimated Cancer Deaths, 2004 

Cause of death US TN

All Cancers 563,700 12,710

Breast (female) 40,110 800

Colorectal 56,730 1,340

Lung and Bronchus 160,440 4,320

Prostate 29,900 590

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US TN

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US TN

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 12,710 are expected 

in Tennessee. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 30,850 

new cases that are likely to be diagnosed in Tennessee. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Tennessee, accounting 

for 15,688 deaths or approximately 28% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 4,037 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Tennessee

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS) 

Tennessee BRFSS

 $82,070 

National Program of Cancer Registries 

 Tennessee Cancer Registry

 $373,117 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Center for Stroke Care Excellence 

 Count On Me! Heart Health is a Numbers Game Campaign

 Middle TN State University’s Healthy Living Inventory

 $300,000

Diabetes Control Program 

 Tennessee Diabetes Prevention and Control Coalition

 $300,000 

National Breast and Cervical Cancer Early Detection Program 

 Tennessee Department of Health Breast and Cervical Cancer Early Detection Program

 $946,257 

National Comprehensive Cancer Control Program 

 Comprehensive Cancer Control Program

 $130,542 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Tennessee Health Promotion and Disease Prevention

 $1,154,195 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010)

 United South and Eastern Tribes, Inc.

 $947,103 

Total $4,233,284

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Tennessee, FY 2003 

Tennessee’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Tennessee that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Tennessee’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among men 

of all races, most notably among African American men (425.0 

per 100,000 in 1990, 392.3 per 100,000 in 2000). 

 A 21.3% decrease in the number of women older than age 50 

who reported not having had a mammogram in the last 2 years 

(from 44.6% in 1992 to 23.3% in 2002). 

 Lower prevalence rates than the corresponding national rates 

for women older than age 18 who reported not having had 

a Pap smear in the last 3 years (14.8% in Tennessee, 16.7% 

nationally) and for individuals who were told by a doctor that 

they had high blood cholesterol (30.1% in Tennessee, 33.1% 

nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Tennessee in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Tennessee Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

CDC mortality data from 2001 indicate that Tennessee had 

the 10th highest heart disease death rate in the nation and the 

3rd highest stroke death rate. Cardiovascular disease (CVD), 

including heart disease and stroke, is the leading cause of death 

in Tennessee. 

Tennessee’s heart disease and stroke death rates are both above 

the national death rates for these diseases. According to CDC 

mortality data, from 1996 to 2000, the heart disease death rate 

in Tennessee was 607 per 100,000, compared with the national 

rate of 536 per 100,000. From 1991 to 1998, the stroke death 

rate in Tennessee was 156 per 100,000, compared with the 

national rate of 121 per 100,000.

Risk factors for heart disease and stroke include high blood 

pressure, high blood cholesterol, diabetes, obesity, and 

smoking. According to data from CDC’s Behavioral Risk 

Factor Surveillance System (BRFSS) for 2003, almost one 

third of adults in Tennessee had high blood pressure (30.3%), 

and almost one third had high blood cholesterol (30.1%). In 

addition, 9.4% had diabetes. More than one quarter of adults 

in Tennessee reported that they were current smokers in 2003 

(25.6%). Data from the BRFSS for the same year indicate that 

more than half of the adults in Tennessee were overweight 

(36.8%) or obese (24.5%). In addition, approximately 80% of 

adults in Tennessee had one or more of these five risk factors. 

Tennessee applied for and received funding from the CDC 

in 2001 to support a state heart disease and stroke prevention 

program. The Tennessee Cardiovascular Health Program seeks 

to lessen the burden of cardiovascular disease and improve 

the cardiovascular health of Tennesseans through changes in 

policy and environment. The program promotes heart healthy 

lifestyles and addresses individuals, targeted risk groups, and 

whole populations. One of the specific successes of the program 

has been its work with the Office of Minority Health—Regional 

Minority Health Coalitions to implement cardiovascular health 

awareness and health literacy projects for African American 

and Hispanic communities across Tennessee. In addition, the 

program allocates resources to sustain and expand partnerships 

between the state’s Diabetes/Cardiovascular Health Disparities 

Collaboratives and Federally Funded Health Centers to improve 

the quality of care for persons with CVD.

Text adapted from Tennessee Department of Health, Tennessee Cardiovascular 

Health Program http://www2.state.tn.us/health/healthpromotion/index.html

Disparities in Health

African Americans, who comprise approximately 12% of the 

U.S. population experience disproportionate health disparities. 

African Americans have higher stroke mortality rates than 

other groups as well as higher prevalence of the risk factors for 

heart disease. Compared with other racial and ethnic minority 

groups, African Americans are more likely to develop lung, 

cervical, colorectal, and prostate cancer at disproportionate 

levels. 

African Americans make up 18% of Tennessee’s population. 

Heart disease is the leading cause of death for African 

Americans in Tennessee. In 2001, the state’s total death rate 

for cardiovascular disease was 330 per 100,000. The CVD 

death rate for African American men was approximately 511 

per 100,000 (compared with approximately 384 per 100,000 

for white men). In 2001, the age-adjusted heart disease rate for 

African American men was 423 per 100,000, while the rate for 

white men was 347 per 100,000. 

Of all other racial and ethnic groups in Tennessee, African 

Americans are more likely to be at risk for heart problems 

related to being overweight. African Americans also have the 

highest rate of obesity (36.8%) when compared with whites 

(23.2%) and Hispanics (24.1%).

African Americans in Tennessee also have higher rates of 

cancer death than whites. CDC mortality data from 2000 

indicate that African American men had an overall cancer 

death rate of 392.3 per 100,000, compared with 278.1 per 

100,000 for white men. African American women also have 

higher cancer death rates than white women. In 2000, the 

cancer death rate was 210.2 per 100,000 for African American 

women, compared with 169.8 for white women.

Other Disparities

 Diabetes: In Tennessee, the diabetes death rate for African 

American men rose from 17 per 100,000 in 1990 to 38 

per 100,000 in 2001—a 124% increase. The death rate for 

African American women rose 69%. 

 Physical Activity: In Tennessee, 75.2% of Hispanics and 

71.2% of whites report that they participated in leisure time 

physical activity during the past month, compared with 

62.4% of African Americans. 

 Cholesterol Screening: In Tennessee, 73.0% of African 

Americans report having had their blood cholesterol 

checked, compared with 81.3% of whites.
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Texas

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Texas

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Texas, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Texas

Estimated Cancer Deaths, 2004 

Cause of death US TX

All Cancers 563,700 34,830

Breast (female) 40,110 2,410

Colorectal 56,730 3,560

Lung and Bronchus 160,440 9,670

Prostate 29,900 1,760

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US TX

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US TX

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 34,830 are expected in 

Texas. About 1.4 million new cases of cancer will be diagnosed 

nationally in 2004 alone. This figure includes 84,530 new 

cases that are likely to be diagnosed in Texas. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Texas, accounting for 

43,199 deaths or approximately 28% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the third leading cause of death, accounting for 10,612 

deaths or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Texas

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Texas BRFSS

 $158,523 

National Program of Cancer Registries 

 Texas Cancer Registry

 $2,372,058 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

 Texas Cardiovascular Quality Improvement Program

 $326,820 

Diabetes Control Program 

 Walk Texas!

 Coordinated Approach to Child Health (CATCH)

 $1,364,132 

National Breast and Cervical Cancer Early Detection Program 

 Breast and Cervical Cancer Control Program

 $6,242,251 

National Comprehensive Cancer Control Program

 Texas Cancer Council

 Texas Cancer Plan: A Guide For Action

 $300,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Texas Tobacco Prevention and Control Program 

 $952,908 

State Nutrition and Physical Activity/Obesity Prevention Program

 All Communities Exercise Day

 $447,589 

Racial and Ethnic Approaches to Community Health (REACH 2010) 

 Latino Education Project, Inc.

 Migrant Health Promotion

$250,000

Total $12,414,281 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Texas, FY 2003 

Texas’ Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Texas that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Texas’ Prevention

Successes

 Statistically significant decreases in cancer deaths among men 

and women across all races, from 284.2 per 100,000 in 1990 

to 250.0 per 100,000 in 2000 for men and from 166.2 per 

100,000 in 1990 to 162.1 per 100,000 in 2000 for women. 

 A 14.9% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 40.2% in 1992 to 25.3% in 2002). 

 A prevalence rate that was lower than the corresponding 

national rate for African American women older than age 18 

who reported not having had a Pap smear in the last 3 years 

(10.1% in Texas versus 11.0% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Texas in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Texas Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD) has been the leading cause of 

death in Texas since 1940. In 2001, CVD claimed close to 

54,000 lives, which accounts for 2 out of every 5 deaths in 

the state. According to Texas hospitalization data, in 2001, 

heart attack, congestive heart failure, and hardening of the 

heart arteries are among the 10 most frequent causes of 

hospitalization of people 45 years and older. The economic 

burden of cardiovascular disease is a major concern: 2 of the 

10 most expensive conditions treated in Texas hospitals are 

heart-related, with charges averaging $65,000.

Cardiovascular disease is the major cause of death among 

minority populations in Texas. The highest mortality rate is 

in the African American population. In 2002, the death rate 

for ischemic heart disease for African Americans was 353 per 

100,000 population, compared with 254.7 per 100,000 for 

whites and 209.6 per 100,000 for Hispanics. Additionally, the 

2002 death rate for stroke among African Americans was 90.4 

per 100,000, compared to 61.9 per 100,000 for whites 

and 50.5 per 100,000 for Hispanics. 

State initiatives to reduce the prevalence of CVD include the 

formation of the Texas Council on Cardiovascular Disease 

and Stroke, which has set goals to reduce CVD mortality by 

promoting healthy lifestyle choices. 

Text adapted from Cardiovascular Disease in Texas: A State Plan with Disease 

Indicators and Strategies for Action (2000) and

Texas Plan to Reduce Cardiovascular Disease and Stroke (2002). 

Disparities in Health

Hispanics represent approximately 13% of the U.S. population. According to the 2000 Census, this population, which 

increased by more than 50% from 1990 to 2000, is the fastest 

growing ethnic group in the nation. Approximately half of the 

Hispanic population in the United States resides in Texas. 

The health status of Hispanics in Texas mirrors the health 

status trends for the Hispanic population throughout the 

United States.

Nationally, heart disease and cancer were the leading causes 

of death for Hispanics in 2001. During this period, cardiovascular disease accounted for 27.1% of all deaths among men 

and 32.6% of deaths among women within this population. 

According to the American Cancer Society, nationally, 

Hispanics experience lower rates of cancer incidence and

death for all cancers combined. Diabetes prevalence is high 

within the Hispanic population. According to the American 

Diabetes Association, 2 million, or 8.2% of all Hispanics in 

the United States have diabetes, compared with the overall 

national figure, 7.2%.

In Texas, Hispanics have the lowest mortality rates for lung 

cancer and colorectal cancers, a higher incidence of cervical 

cancer, and a higher incidence of diabetes, compared with 

other racial and ethnic groups in the state. 

Other Disparities

 Physical Activity: Compared with other racial and ethnic 

groups, Hispanics in Texas had the highest rate of physical 

inactivity (37.3%), compared with their African American 

(33.7%) and white (22.3%) counterparts. This number 

represents an increase of more than 10% from 2002 data. 

 Colorectal Cancer Screening: In Texas, 69.9% of 

Hispanics have never had a sigmoidoscopy or colonoscopy, 

compared with 59.9% of African Americans and 50% of 

whites. 

 Breast Cancer Screening: In 2001, Hispanic women 

in Texas were among the least likely to have had a 

mammogram in the last year (58.2%, compared with 

61.8% of African Americans and 60.5% of whites). 

 Cervical Cancer Screening: Hispanic women in 2001 

were more likely than white women to have had a Pap test 

in the last 3 years (91.1% of Hispanic women, compared 

with 85.6% of white women). 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Healthy Texans 2010 Goals: Reducing Cardiovascular Disease

Risk Factors for Cardiovascular 

Disease (18 years and older)

Baseline for

Texas

Texas 2010 

Target

Reduce the proportion of adults 

with high blood pressure 23.7% 16%

Reduce the proportion of adults 

with high blood cholesterol 30.8% 17%

Reduce the number of adults who 

smoke cigarettes 22.0% 12%

Reduce the proportion of adults 

who are physically inactive 27.8% 20%

Reduce the proportion of obese 

adults 25.3% 15%

Source: Healthy Texans 2010
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Utah

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Utah

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Utah, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Utah

Estimated Cancer Deaths, 2004 

Cause of death US UT

All cancers 563,700 2,620

Breast (female) 40,110 200

Colorectal 56,730 260

Lung and Bronchus 160,440 440

Prostate 29,900 140

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US UT

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US UT

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 2,620 are expected in 

Utah. About 1.4 million new cases of cancer will be diagnosed 

nationally in 2004 alone. This figure includes 6,360 new cases 

that are likely to be diagnosed in Utah. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Utah, accounting for 

2,896 deaths or approximately 23% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 870 deaths or 

approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Utah

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Utah BRFSS

 $180,920 

National Program of Cancer Registries $0

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Gold Medal School Initiative

 $948,335 

Diabetes Control Program 

 Utah Diabetes Prevention and Control Program

 $881,520 

National Breast and Cervical Cancer Early Detection Program 

 Utah Cancer Control Program

 $2,032,209 

National Comprehensive Cancer Control Program 

 Utah Cancer Control Program

 $659,483 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Utah Tobacco Prevention and Control Program

 $1,196,502 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,898,969

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Utah, FY 2003 

Utah’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Utah that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Utah’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

men across all races (from 192.9 per 100,000 in 1990 to 

183.6 per 100,000 in 2000), and in cancer deaths among 

white Hispanic women (183.6 per 100,000 in 1990 versus 

69.8 per 100,000 in 2000). 

 An 11.9% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 36.6% in 1992 to 24.7% in 2002). 

 Lower prevalence rates than the corresponding national 

rates for individuals who reported they had a diagnosis of 

hypertension (18.8% in Utah versus 24.8% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Utah in the areas 

of cancer, heart disease, stroke, and related risk factors. 
4

Utah Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight:

Cardiovascular Disease

From 1996 through 1998, Utah’s age-adjusted death rate for 

cardiovascular disease (CVD) was the second lowest in the 

nation. Over time, age-adjusted death rates for CVD for both 

men and women have been decreasing in Utah and across the 

country. This decline is likely due to improved medical treatment 

and greater emphasis on reducing the major controllable 

cardiovascular risk factors.

However, CVD is still Utah’s leading cause of death and 

disability, accounting for approximately 4,000 deaths each year. 

Despite the common belief that CVD is a disease that primarily 

affects men, in actuality, it is a serious problem affecting both 

men and women alike. From 1998 to 2000, the percentage of all 

CVD deaths was higher for women than for men (35% compared 

with 31%). Age was also a risk factor for death for CVD. The 

death rates for men increased dramatically after age 44, while the 

death rates for women increased gradually. Thirty-nine percent 

of male CVD deaths occurred under age 75, compared with only 

20% of female CVD deaths. The figure below illustrates Utah’s 

CVD death rates for men and women at different ages. 

Utah addresses CVD as a public health concern through its 

Alliance for Cardiovascular Health. The Alliance is the state’s 

primary vehicle for implementing the state’s plan to reduce the 

burden of CVD. Member organizations include county and local 

governments, private businesses, nonprofit agencies, schools, 

health care organizations, and other groups. 

Text adapted from Milestones Report 2002: Cardiovascular Disease in Utah 

and Cruising the Heart Highway, Heart Disease & Stroke Prevention Program.

Disparities in Health

Despite the numerous interventions developed specifically to 

address health issues for all underserved populations, racial and 

ethnic disparities in health continue to be a compelling public 

health problem. In Utah, Hispanics are the largest minority 

group. The size of Utah’s Hispanic population more than 

doubled during the 1990s, growing by 138%—a trend that is 

projected to continue. In 2000, there were over 200,000 Hispanic 

residents, comprising more than 9% of the state’s population. 

Data from the 2001 Utah Hispanic Health Survey, conducted by 

the Utah Department of Health’s Bureau of Health Promotion, 

indicate that the Hispanic population is at a higher risk for many 

factors that lead to heart disease and other chronic diseases.

Three out of five Hispanic adults in Utah (60.7%) were 

overweight or obese, compared to 52.6% of all Utah adults. 

Utah’s Hispanic adults were slightly less likely to participate in 

regular physical activity than non-Hispanic adults (47.2% and 

52.1%, respectively). Nationally, Hispanic adults are less likely 

to report that they smoke than non-Hispanic adults. In Utah, 

the trend is reversed: nearly 1 out of 5 Hispanic adults smoke 

(19.3%), compared with the national rate for Hispanics (13.3%). 

In addition, Utah’s Hispanic men are much more likely to smoke 

than non-Hispanic men (25.7% for Hispanic men, compared 

with 14.4% for non-Hispanic men).

Rates of death from stroke are higher in Utah for Hispanics 

(98 per 100,000) than they are for Hispanics nationally (79 per 

100,000). Data from the 2001 Utah Hispanic Health Survey 

indicate that only 46.2% of Utah Hispanic adults reported that 

they had changed their behavior to lower their risk of heart 

disease or stroke.

Other Disparities

 Smoking: College graduates (5.1%) are less likely to 

smoke than those with a high school diploma (17.2%) or 

less (30.4%).

 High Blood Pressure: Utah residents who are college 

graduates are less likely to report having been told that they 

have high blood pressure (15.7%) than those who have less 

than a high school education (23.1%).

 Nutrition: Utah residents with annual incomes of more than 

$50,000 are more likely to report that they consume 5 or 

more servings of fruits and vegetables per day (22.6%) than 

those with annual incomes of less than $15,000 (16.3%).

Text adapted from Hispanic Health in Utah Report, 

Utah Department of Health, 2002. 

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

18-44 45-54 55-64 65-74 75+

500

(rates per 100,000 per year) 

0

1,000

1,500

2,000

2,500

3,000

3,500

Women Men

Source: Utah death certificate data; Utah population estimates from the Utah 

Governor’s Office of Planning and Budget UPED Model, January 2000

Age Group

Age-Adjusted Rates of Death from Heart Disease by Age 

and Sex, 1998-2000
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Vermont

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Vermont

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Vermont, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Vermont

Estimated Cancer Deaths, 2004 

Cause of death US VT

All Cancers 563,700 1,300

Breast (female) 40,110 110

Colorectal 56,730 130

Lung and Bronchus 160,440 370

Prostate 29,900 60

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US VT

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US VT

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 1,300 are expected 

in Vermont. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 3,150 

new cases that are likely to be diagnosed in Vermont. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Vermont, accounting 

for 1,370 deaths or approximately 27% of the state’s deaths in 

2002 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 333 deaths or 

approximately 7% of the state’s deaths in 2002. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Vermont

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Vermont BRFSS

 $180,185 

National Program of Cancer Registries 

 Vermont Cancer Registry

 $344,534 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program

 Vermont Diabetes Control and Prevention Program

 $259,220 

National Breast and Cervical Cancer Early Detection Program 

 Ladies First

 $1,192,362 

National Comprehensive Cancer Control Program 

 Division of Health Surveillance 

 Chronic Disease Program

 $129,536 

WISEWOMAN 

 A New Leaf...Choices for Healthy Living

 Active Living Every Day

 $521,644 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Vermont Tobacco Prevention and Control Program

 $1,090,563 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $3,718,044 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Vermont, FY 2003 

Vermont’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Vermont that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Vermont’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

white men (296.1 per 100,000 in 1990 versus 240.3 per 

100,000 in 2000) and white women (173.0 per 100,000 in 

1990 versus 171.7 per 100,000 in 2000). 

 A 15.6% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 34.2% in 1992 to 18.6% in 2002) 

 A lower prevalence rate than the corresponding national rate 

for self-reported diabetes (5.8% in Vermont versus 7.1% 

nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Vermont in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Vermont Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Stroke

Stroke is the third leading cause of death in Vermont and in 

the United States. According to CDC’s Cardiovascular Health 

Program, from 1996 to 2000, the Vermont age-adjusted death 

rate for stroke was 115 per 100,000. Since 1990, mortality rates 

have not declined significantly; however, stroke hospitalization 

has increased 2.9% per year. This increase was not evenly distributed across all age groups: stroke hospitalizations increased 

4.0% for Vermonters ages 55 to 74, while the rate for those ages 

75 and older increased 1.9% per year. 

Modifiable risk factors for stroke include high blood pressure, 

cirgarette smoking, and obesity. According to 2003 data from 

CDC’s Behavioral Risk Factor Surveillance System, nearly one 

quarter of Vermont adults (23.1%) reported that they had been 

told that they had high blood pressure. Almost 20% of adults in 

Vermont smoked and more than half of all Vermont adults were 

overweight (35.6%) or obese (18.9%). In 1997, three quarters of 

the state’s adults had at least one of these risk factors, 29.0% 

had at least two of these risk factors, and 3.0% of Vermont 

adults had all three of these risk factors.

Two other important risk factors for stroke are high blood 

cholesterol and diabetes. In 2003, 30.9% of Vermonters reported 

that they had been told that they have high blood cholesterol. In 

addition, 5.8% reported that they had been told that they have 

diabetes. Physical inactivity and poor nutrition are risk factors 

for stroke, diabetes, and high blood pressure. More than two 

thirds (67.5%) of Vermont adults consumed less than 5 servings 

of fruits and vegetables per day and 18.7% did not participate in 

any leisure time physical activity during the past month.

The current plateau in Vermont’s stroke mortality rates, the 

state’s increase in stroke hospitalizations, and the large number 

of older Vermonters with risk factors for stroke suggest that 

additional strategies are needed to further reduce the occurrence 

of stroke. Currently, the Vermont Department of Health supports 

a variety of programs designed to reduce risk factors for stroke. 

One of these programs is the Strong Living Program, a comprehensive exercise program for adults age 50 and older that 

incorporates strength, balance, and flexibility exercises and 

general information about physical activity. The Department 

of Health also supports a cardiovascular disease education 

program, a diabetes control program, and a tobacco control 

program. 

Text adapted from Chronic Disease in Vermont: Stroke, Vermont Department of 

Health, Disease Control Bulletin (Volume 1, Issue 2, 1999).

Disparities in Health

Nationally, heart disease is the number one killer of women, 

accounting for approximately one third of all deaths among 

women in the United States. Lung, breast, and colorectal cancers 

are the leading causes of cancer deaths in both men and women. 

Cancer death rates have begun to decline for men, but they have 

increased for women. Breast cancer continues to be the most 

commonly diagnosed cancer among women in the United States. 

White women have a higher incidence of breast cancer after 

age 40, while African American women have a slightly higher 

incidence rate before age 40; however, African American women 

are more likely to die from the disease at any age. 

Death rates for women in Vermont mirror these national trends. 

In 2001, the three leading causes of death for the state’s women—

heart disease, followed by cancer and stroke—together accounted 

for approximately 58% of all deaths among Vermont women. 

More men in Vermont die of heart disease than women (595 per 

100,000 men, compared with 393 per 100,000 women), but more 

women of all ages die from stroke than men. Of the three leading 

causes of cancer death among women in Vermont—lung cancer, 

breast cancer, and colorectal cancer—breast cancer is the most 

frequently diagnosed cancer, and representing 30% of all newly 

diagnosed cancers affecting women in the state. Colorectal cancer 

is the second most frequently newly diagnosed cancer among 

women in Vermont (13%, compared with 11% among men). 

In Vermont, from 1995 to 1999, 36% of breast cancers were 

detected by mammography (compared with the 2% that were 

detected from 1974 to 1984). In 2002, only 53.9% of women 

aged 50 and older with household incomes of below $15,000 

received screening, compared with 66.3% of women of the same 

age group with incomes of more than $50,000. Data from the 

National Cancer Institute’s Surveillance, Epidemiology, and End 

Results Program system indicated that Vermont’s cervical cancer 

incidence rate was 10.4 per 100,000, which was slightly higher 

than the national average of 8.1 per 100,000.

Other Disparities

 Physical Activity: Women in Vermont are slightly less likely 

to be physically active than their male counterparts (80.6% 

versus 82.0%).

 Overweight: Women in Vermont are less likely to be overweight or obese than men (46.5% versus 64.6%).

 Nutrition: Women are more likely to consume 5 or more 

fruits and vegetables per day than men (38.4% versus 26.2%).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Virginia

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Virginia

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Virginia, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Virginia

Estimated Cancer Deaths, 2004 

Cause of death US VA

All Cancers 563,700 12,850

Breast (female) 40,110 1,180

Colorectal 56,730 1,370

Lung and Bronchus 160,440 3,740

Prostate 29,900 660

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US VA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US VA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 12,850 are expected 

in Virginia. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 31,190 

new cases that are likely to be diagnosed in Virginia. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Virginia, accounting for 

14,913 deaths or approximately 26% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 4,129 deaths 

or approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Virginia

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Virginia BRFSS

 $217,034 

National Program of Cancer Registries

Virginia Cancer Registry

 $560,436 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Healthy Pathways

 $1,200,000

Diabetes Control Program 

 Virginia Diabetes Control and Prevention Program 

 $350,000 

National Breast and Cervical Cancer Early Detection Program 

 Virginia Breast and Cervical Cancer Early Detection Program 

$2,345,015 

National Comprehensive Cancer Control Program 

 Cancer Prevention and Control

 $290,000 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Virginia Tobacco Prevention and Control Program

$889,735 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $5,852,220

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Virginia, FY 2003 

Virginia’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Virginia that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Virginia’s Prevention

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among Hispanic women (152.0 per 100,000 in 

1990 versus 101.4 per 100,000 in 2000). 

 A 12.4% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 34.9% in 1992 to 22.5% in 2002).

 A prevalence rate that was lower than the national 

corresponding rate for women older than age 18 who 

reported not having had a Pap smear in the last 3 years 

(12.8% in Virginia versus 16.7% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is 

a breakdown of the CDC’s funding awards to Virginia in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Virginia Profiling the Leading Causes of Death in the United States

Chronic Disease Highlight: 

Cardiovascular Disease and Diabetes

In 2001, CDC mortality data indicated that Virginia had the 

nation’s 27th highest heart disease death rate and the 11th 

highest stroke death rate. From 1996 to 2000, Virginia had 

a heart disease death rate of 520 per 100,000, slightly lower 

than the national rate of 536 per 100,000. However, from 

1991 to 1998, the state had a stroke death rate that was higher 

than the national rate (137 per 100,000 compared with 121 

per 100,000). Behavioral Risk Factor Surveillance System 

data from 2000 show that in Virginia, 50% of respondents 

who were told by a doctor that they had suffered a heart attack 

or myocardial infarction were under age 65, and 30% of 

respondents who were told by a doctor that they had suffered a 

stroke were under age 65. African Americans in Virginia under 

age 65 had the highest CVD death rate of all racial and ethnic 

groups. 

Heart disease is the leading cause of diabetes-related deaths 

in Virginia. According to Diabetes in Virginia 2000, adults 

with diabetes have higher rates of heart disease and are 

more likely to suffer a stroke than adults without diabetes. 

According to Virginia hospitalization data from 1999, persons 

with diabetes are 8 times more likely to be hospitalized for a 

major cardiovascular disease than nondiabetics are. Diabetes 

mortality data from 1995 to 1999 show that more diabetesrelated deaths were due directly to major cardiovascular 

diseases (1,757) than were due to diabetes.

The Virginia Department of Health began receiving funds 

from CDC in 1999 to support a state heart disease and stroke 

prevention program, entitled the Cardiovascular Health Project. 

The program has worked to establish a statewide coalition, 

“Healthy Pathways,” that represents over 75 organizations from 

universities, businesses, nonprofit groups, and government. The 

coalition is writing a “Call to Action Plan” to accompany the 

State Cardiovascular Risk Reduction Plan, which will outline 

partnerships and resources that coalition members will commit 

to implement the plan. In addition, the project has promoted the 

development of a statewide network of faith initiative partners 

focused on increasing the cardiovascular health of African 

American church congregation members. Strategies emphasize 

supportive policies, physical and social environments, and 

education.

Text adapted from Chronic Disease Prevention and Control in Virginia: 

Data Highlights (2003) and the Cardiovascular Health Project Web site: 

www.vahealth.org/cvd.

Disparities in Health

African Americans comprise approximately 12% of the U.S. 

population and experience disproportionate health disparities. 

They tend to have higher rates of behavioral risk factors for 

chronic diseases as well as higher heart disease, stroke, and 

cancer mortality rates.

African Americans, who make up approximately 19.6% of 

Virginia’s population, experience high rates of risk factors for 

heart disease and cancer, and consequently high heart disease 

and cancer death rates. Data from CDC’s 2003 Behavioral Risk 

Factor Surveillance System (BRFSS) indicate that African 

Americans were less likely than whites to consume 5 or more 

servings of fruits and vegetables per day (22.8% versus 25.9%) 

and were less likely to participate in leisure time physical 

activity than whites (69.9% versus 79.4%). African Americans 

also were more likely to be obese than whites (34.1% versus 

20.3%), more likely to have high blood pressure than whites 

(29.3% versus 23.8%), and more likely to report having been 

told that they had diabetes than whites (9.3% versus 6.8%).

Given the prevalence rates of the above risk factors for heart 

disease and stroke, it is not surprising that African Americans 

also have higher heart disease and stroke death rates than whites. 

From 1996 to 2000, African Americans in Virginia had a heart 

disease death rate of 639 per 100,000, compared with the heart 

disease death rate for whites, 504 per 100,000. From 1991 to 

1998, African Americans in Virginia had a stroke death rate of 

188 per 100,000, compared with 128 per 100,000 for whites.

Other Disparities

 Breast Cancer Screening: 2002 BRFSS data indicate that 

African American women in Virginia were more likely to 

report having had a mammogram in the last 2 years (86.7%) 

than Hispanic women (84.3%) or white women (79.9%).

 Cervical Cancer: Although 2002 BRFSS data indicate that 

African American women in Virginia (93.1%) were more 

likely to report having had a Pap smear in the last 3 years 

than white women (89.7%), from 1997 to 2001, African 

American women had a cervical cancer death rate that was 

more than twice as high as the rate for white women (5.1 per 

100,000 versus 2.2 per 100,000).

 Prostate Cancer: African American men in Virginia in 2000 

had a prostate cancer death rate that was more than 3 times as 

high as the rate for white men (81.9 per 100,000 compared to 

26.7 per 100,000).

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Washington

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Washington

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Washington, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Washington

Estimated Cancer Deaths, 2004 

Cause of death US WA

All Cancers 563,700 11,280

Breast (female) 40,110 750

Colorectal 56,730 1,050

Lung and Bronchus 160,440 3,250

Prostate 29,900 630

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US WA

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US WA

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 11,280 are expected 

in Washington. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 27,380 

new cases that are likely to be diagnosed in Washington. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Washington, accounting 

for 11,281 deaths or approximately 25% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 3,765 deaths 

or approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Washington

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Washington BRFSS

 $293,854 

National Program of Cancer Registries

Washington State Cancer Registry

 $728,016 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program

No program identified

 $350,000 

Diabetes Control Program 

 Diabetes Electronic Management Systems (DEMS)

 National Diabetes Education Program

 Chronic Disease Self-Management Support Network

 $898,905 

National Breast and Cervical Cancer Early Detection Program 

 Washington Breast and Cervical Health Program

 $3,939,831 

National Comprehensive Cancer Control Program 

 Comprehensive Cancer Control Program

 $848,915 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 Washington Tobacco Prevention and Control Program

 $1,239,602 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Be Healthy. Be Active.

 Healthy Communities Moses Lake Trails/Path Systems

 $800,000 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $9,099,123 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Washington, FY 2003 

Washington’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Washington that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Washington’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men of all races (257.3 per 100,000 in 1990 versus 235.3 per 

100,000 in 2000) and among women of all races (172.7 per 

100,000 in 1990 compared with 169.8 per 100,000) in 2000.

 A 9.9% decrease in the number of women older than age 50 

who reported not having a mammogram in the last 2 years 

(from 31.1% in 1992 to 21.2% in 2002). 

 A higher prevalence rate than the corresponding national rate 

for self-reported participation in leisure time physical activity 

(82.3% in Washington versus 76.9% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Washington in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Washington Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: Obesity 

Obesity is a serious problem in the United States and in 

Washington state. Obese and overweight individuals are more 

prone to develop hypertension, elevated blood cholesterol, 

and diabetes, each of which increases the risk of heart disease. 

More than half of the adult population, both nationally and 

in Washington state, is either overweight or obese, and these 

figures increase each year. The prevalence of obesity in 

Washington has doubled in the past decade: data from CDC’s 

Behavioral Risk Factor Surveillance System (BRFSS) indicate 

that in 1990, 9.4% of adults in Washington were obese; by 

2003, 21.7% were obese. 

Obesity is not only a problem for adults. In the United States, 

the percentage of young people who are overweight has more 

than doubled in the last 20 years. In 1999, approximately 7% 

of Washington youth in grades 9 through 12 were overweight 

and 14% were at risk of being overweight (between the 85th

and 95th percentile for body mass index). In addition, in 2000, 

26% of Washington children participating in WIC were above 

the 90th percentile of weight for height.

The social and financial costs of obesity are not distributed 

evenly among Washington’s residents. African Americans and 

American Indians/Alaska Natives have the highest prevalence 

of obesity. Data from the BRFSS indicate that in 2003, 30.5% 

of African Americans, 23.7% of Hispanics, and 20.9% of 

whites were obese.

Adults who did not graduate from college have a higher 

prevalence of obesity than those who did graduate from college 

(15.2% of college graduates are obese, compared with 25.0% of 

those with a high school degree or less).

Poor nutrition and physical inactivity are risk factors associated 

with obesity. Data from the BRFSS for 2003 indicate that 

only 23.3% of Washington’s residents consumed more than 5 

servings of fruits and vegetables per day and that 45.6% did 

not meet the recommended guidelines for moderate physical 

activity. 

In order to address the issue of obesity, the Washington State 

Nutrition and Physical Activity Advisory Group was formed. 

This collaborative group is working to develop policy and 

environmental approaches to slow the increasing proportion 

of adults who are obese, reduce rates of chronic disease, and 

improve the quality of life in Washington. 

Text adapted from Washington State Nutrition and Physical Activity Plan; 

Policy and Environment Approaches (2003).

Disparities in Health

About 3.7% of the U.S. population consider themselves to be 

of Asian or Pacific Island descent, according to the 2000 U.S. 

Census. These data also indicate that Asian/Pacific Islanders 

represented 5.9% of population in Washington, which gives 

Washington the third highest population of Asian American/

Pacific Islanders in the United States, following Hawaii (51%) 

and California (11.2%). 

Asian/Pacific Islander populations in the United States tend 

to be healthy. According to the American Cancer Society, this 

population has lower rates of death from breast cancer (12.5 

per 100,000) and colorectal cancer (13.1 per 100,000) than 

any other racial or ethnic group. According to Behavioral 

Risk Factor Surveillance System data from 1998 to 2000, in 

Washington state, the Asian/Pacific Islander population is less 

likely to smoke than whites (15.8% versus 21.3%). These data 

also indicate that in comparison with other racial and ethnic 

groups in Washington, Asian/Pacific Islanders are less likely to 

be obese than whites (9.6% versus 18.5%). 

Although chronic disease rates are low among Asian/Pacific 

Islanders, this population is underrepresented in the health care 

workforce, leading to potential disparities in the provision of 

health care because of language and cultural barriers. The State 

Board of Health convened a Health Disparities committee to 

begin to address the health disparities in Washington state. The 

committee is working to improve the diversity of the health care 

workforce in order to build a more diverse health care system.

Other Disparities

 Physical Activity: Hispanics (42.9%) and African Americans 

(55.0%) in Washington are less likely to meet the recommended guidelines for moderate physical activity than 

whites (55.6%).

 High Blood Pressure: African Americans in Washington 

(28.1%) are more likely to report having been diagnosed 

with high blood pressure than whites (24.8%).

 Diabetes: African Americans are also more likely to report 

having been diagnosed with diabetes (9.0%) than whites 

(6.5%) or Hispanics (4.7%).

 Breast Cancer: Although African American women are 

more likely to report having had a mammogram in the last 

2 years (83.2%) than white women (78.8%), African 

American women have higher breast cancer death rates 

(34 per 100,000) than white women (25.4 per 100,000).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Wisconsin

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Wisconsin

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Wisconsin, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Wisconsin

Estimated Cancer Deaths, 2004 

Cause of death US WI

All Cancers 563,700 10,780

Breast (female) 40,110 750

Colorectal 56,730 1,120

Lung and Bronchus 160,440 2,820

Prostate 29,900 500

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US WI

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US WI

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will die 

of cancer. Of these annual cancer deaths, 10,780 are expected 

in Wisconsin. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 26,160 

new cases that are likely to be diagnosed in Wisconsin. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Wisconsin, accounting 

for 13,023 deaths or approximately 28% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the third leading cause of death, accounting for 3,658 deaths 

or approximately 8% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Wisconsin

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Wisconsin BRFSS

 $185,583 

National Program of Cancer Registries 

 Wisconsin Cancer Reporting System

 $472,881 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Great Lakes Regional Stroke Network

 Lipid Management Project

 Epidemiology Task Force

 Wisconsin Cardiovascular Health Alliance

 $350,000 

Diabetes Control Program 

 The Wisconsin Collaborative Diabetes Quality Improvement Project

 Wisconsin Primary Health Care Diabetes Collaborative

 Wisconsin Diabetes Advisory Group (DAG)

 $765,527 

National Breast and Cervical Cancer Early Detection Program 

 Wisconsin Well Woman Program

 $3,151,995 

National Comprehensive Cancer Control Program 

 Wisconsin Department of Health and Family Services

 $422,958 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Wisconsin Tobacco Control Program

 $1,141,265 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Eat Well Play Hard

 Prevention Projects

 Walk to School Day

 $443,005 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $6,933,214 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Wisconsin, FY 2003 

Wisconsin’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Wisconsin that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Wisconsin’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, from 272.7 per 100,000 in 1990 to 

240.6 per 100,000 in 2000.

 A 19.0% decrease in the number of women older than age 50 

who reported not having a mammogram in the last 2 years 

(from 36.7% in 1992 to 17.7% in 2002). 

 A higher prevalence rate than the corresponding national 

rate for self-reported participation in leisure time physical 

activity (81.2% in Wisconsin versus 76.9% nationally).

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Wisconsin in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Wisconsin Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

In 2001, about 35% of all deaths in Wisconsin (16,681) were 

due to cardiovascular disease (CVD). CVD is the leading cause 

of death among men and women of all racial and ethnic groups 

in Wisconsin. Annually, CVD causes more deaths than cancer, 

AIDS, automobile crashes, domestic abuse, and alcohol abuse 

combined. 

The 2002 Cardiovascular Disease Surveillance Summary

published by the Wisconsin Bureau of Chronic Disease 

Prevention and Health Promotion reported that the estimated 

annual total cost of CVD to the state was $5.2 billion—or more 

than $1,000 for every man, woman, and child. In 2000, there 

were almost 94,000 hospitalizations for CVD, accounting for 

over $1.6 billion in charges. Total costs included direct costs 

(health care, provider visits, hospital and nursing home services, 

medications, home care) and indirect costs (lost productivity). 

Much of the health and economic burden of CVD can be 

prevented. Data from the 2003 CDC Behavioral Risk Factor 

Surveillance System indicate that Wisconsin residents have a 

variety of risk factors for CVD, including high rates of physical 

inactivity, obesity, and high blood pressure. Twenty-four percent 

of Wisconsin’s residents reported having been told by a health 

care provider that they have high blood pressure and 45.3% 

reported that they do not meet the recommended guidelines for 

moderate physical activity. In addition, only 21.5% reported 

consuming 5 or more servings of fruits and vegetables per day. 

Consequently, 36.3% of the population is overweight and 21.6% 

is obese. Smoking, another risk factor for CVD, is prevalent in 

Wisconsin—more than one fifth of adults in Wisconsin reported 

that they were current smokers (22.0%). 

Heart disease can be prevented by increasing physical activity, 

maintaining a normal body weight, and eating a healthy diet. 

The Wisconsin Department of Health began receiving funds 

from CDC in 2000 to support a state heart disease and stroke 

prevention program. The Cardiovascular Health Program in 

Wisconsin is working to create environments that support or 

encourage healthier lifestyles, so that Wisconsin residents can 

help to reduce the state’s CVD burden. In addition, the program 

is building partnerships with residents, advocacy groups, health 

organizations, health professionals, local health departments, 

and other governmental and nongovernmental agencies to 

decrease risk factors for heart disease and stroke. 

Text adapted from Wisconsin Cardiovascular Disease Surveillance Summary (2002). 

Disparities in Health

About 4.2% of the US population considers themselves to be of 

Asian or Pacific Island descent. Only about 2% of Wisconsin’s 

residents are Asian, however, over 70% of the state’s Asian/

Pacific Islander population are Hmong refugees from Laos and 

their descendants, who emigrated to Wisconsin beginning in 

the 1970s. From 1990 to 2000, the Hmong population more 

than doubled from 16,373 to 33,791. The Hmong population 

tends to be concentrated in selected counties across the state, 

especially in Milwaukee, Dane, Waukesha, Brown, La Crosse, 

Marathon, Sheboygan, Eau Claire, Outagamie, and Winnebago 

counties. 

Asian/Pacific Islander populations in the United States tend 

to be healthy; according to the American Cancer Society, this 

population has lower rates of death from breast cancer (12.5 

per 100,000) and colorectal cancer (13.1 per 100,000) than 

any other racial or ethnic group. In Wisconsin, between 1996 

and 2000, data from the Wisconsin Behavioral Risk Factor 

Surveillance System indicate that Asian/Pacific Islander adults 

had almost the same smoking rate as whites (22% compared 

to 23%). Asian/Pacific Islander youth were also as likely as 

white youth to smoke (10% compared with 9%). Asian/Pacific 

Islanders were less likely to be overweight or obese than whites 

(35% compared with 56%). 

However, language and cultural issues present barriers to 

accessing health care. In a report published by the University 

of Wisconsin Extension program, Hmong families indicated 

that the high cost of health insurance prevented some 

Hmong families from seeking health care. In addition, the 

Hmong families wanted to use providers that considered 

using traditional Hmong medical practices, including herbal 

remedies. 

Other Disparities

 High Blood Pressure: African Americans were more 

likely to report having been told that they have high blood 

pressure (27.0%) than whites (24.6%).

 Physical Inactivity: African Americans (35.9%) and 

Hispanics (27.4%) were more likely to report that they did 

not participate in any leisure time physical activity during 

the past month than whites (17.6%).

 Diabetes: African Americans were almost twice as likely 

as whites to report having been diagnosed with diabetes 

(10.7% of African Americans, compared with 5.9% of 

whites).
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

West Virginia

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

United States West Virginia

350

400

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and West Virginia, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States West Virginia

Estimated Cancer Deaths, 2004 

Cause of death US WV

All Cancers 563,700 4,710

Breast (female) 40,110 300

Colorectal 56,730 490

Lung and Bronchus 160,440 1,640

Prostate 29,900 200

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US WV

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US WV

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 4,710 are expected 

in West Virginia. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 11,430 

new cases that are likely to be diagnosed in West Virginia. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart

disease is the leading cause of death in West Virginia, accounting for 6,325 deaths or approximately 30% of the state’s deaths 

in 2001 (the most recent year for which data are available). 

Stroke is the fourth leading cause of death, accounting for 

1,272 deaths or approximately 6% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States West Virginia

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 West Virginia BRFSS

 $122,117 

National Program of Cancer Registries 

 West Virginia Cancer Registry

 $323,964 

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program 

 Ebenezer Medical Outreach

 The West Virginia Restaurant Survey 

 Wheeling Walks Program

 $1,000,000 

Diabetes Control Program 

 Diabetes Control and Prevention Program

 $859,827 

National Breast and Cervical Cancer Early Detection Program

 Breast and Cervical Cancer Screening Program

 $3,980,000 

National Comprehensive Cancer Control Program

 Comprehensive Cancer Control Program

 $686,353 

WISEWOMAN 

 Cookin’ Up Health

 $442,492 

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program

 West Virginia Tobacco Prevention and Control Program

 $1,090,470 

State Nutrition and Physical Activity/Obesity Prevention Program 

 Aerobics Classes in African American Churches (CVH Minority Initiatives)

 Community Based Initiative Grants 

 School Health Index

 State Health Education Conference

 Walk Across West Virginia

 West Virginia State Trails Plan

 West Virginia on the Move

 $449,255 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $8,954,478 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for West Virginia, FY 2003 

West Virginia’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in West Virginia that fall into other health areas. A listing of these programs can be found 

at http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of West Virginia’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men and women across all races, with the greatest decrease 

occurring among African American men (382.0 per 100,000 

in 1990 versus 340.3 per 100,000 in 2000).

 A 24.7% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 48.9% in 1992 to 24.2% in 2002). 

 A 6.9% decrease in the percent of women who reported not 

having had a Pap smear in the last 3 years (from 25.3% in 

1992 to 18.4% in 2002). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to West Virginia in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

West Virginia Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight: 

Obesity

Obesity is one of the most serious risk factors for a variety of 

chronic diseases, such as heart disease, diabetes, and hypertension. The obesity prevalence in West Virginia has been consistently higher than in the United States as a whole since statelevel monitoring began through CDC’s Behavioral Risk Factor 

Surveillance System (BRFSS). In 1990, the West Virginia rate 

for adult obesity was 15%, compared with 11.6% for the United 

States. By 2003, the state obesity rate had increased to 27.6%, 

compared with 22.2% for the United States. 

Poor nutrition and physical inactivity are risk factors for 

obesity. Data from the BRFSS indicate that in 2003, 57.3% 

of people in West Virginia did not meet the recommended 

guidelines for moderate physical activity, compared with the 

national average of 52.8%. In addition, only 18.7% of people 

in West Virginia reported eating 5 or more servings of fruits 

and vegetables per day, compared with the national average 

of 22.5%.

Data from the 2002 BRFSS show that West Virginians who are 

obese are more likely than those at a healthy weight to have 

suffered a heart attack; been diagnosed with hypertension, 

diabetes, and/or asthma; or to have been limited in their 

activities because of back pain. While more West Virginians 

who are obese report that they are trying to lose weight, they 

are less likely to be physically active or to eat a diet that 

includes at least five servings of fruits and vegetables per day.

Youth in West Virginia are less active than youth nationwide, 

according to data from CDC’s 1999 Youth Risk Behavior 

Survey. Those data show that only 38.2% of the state’s high 

school students were enrolled in physical education classes 

in that year, compared with a national average of 56.1%. 

Less than half of these students (49.5%) participated on a 

sports team, while nationally, 55.1% of students reported 

participating in a team sport. 

In 1993, the West Virginia Bureau of Public Health established 

the West Virginia Coalition of Physical Activity to address the 

increase in sedentary lifestyles of state residents and to provide 

a platform to support Healthy People 2010 objectives. Each 

year, the Coalition coordinates Walk Across West Virginia, a 

statewide physical activity campaign that recruits over 6,300 

participants.

Text adapted from Obesity: Facts, Figures, Guidelines (2002).

Disparities in Health

Almost 20% of the U.S. population lives in rural areas. People 

in these rural areas have a higher risk of heart disease, diabetes, 

and cancer, which is attributable in part to a population that 

is older, poorer, and less educated. In addition, access to 

physicians and other health care services is limited. People 

living in rural areas are also more likely to use tobacco.

West Virginia is the second most rural state in the United 

States, with 64% of its population living in communities of 

fewer than 2,500 people and 45 of its 55 counties designated as 

“nonmetropolitan” by the Bureau of the Census. West Virginia 

is located in Appalachia, a mountainous region in the eastern 

United States where, from 1994 to 1998, the death rate for all 

cancers was significantly higher (176.3 per 100,000) than the 

corresponding national rate (166.7 per 100,000). 

Rural Appalachian culture influences health in several important 

ways. Appalachians inhabit a particular mountain environment 

that separates them physically from other cultural groups 

and the resources of those groups. Thus, rural Appalachian 

culture has developed in a historical context of isolation and 

exploitation, which has assured major differences between 

Appalachian culture and the dominant urban culture. Many 

Appalachian residents are reluctant to use the mainstream 

medical system except for emergencies. Health interventions 

that are developed with consideration for Appalachian culture, 

values, language, and behaviors have been most successful in 

altering the health status of mountain dwellers. 

Other Disparities

 Cancer: African American men in West Virginia in 2000 had 

a higher cancer death rate than whites (340.3 per 100,000, 

compared with 278.6 per 100,000). Among women, however, 

the death rate in 2000 was lower for African Americans 

than whites (187.6 per 100,000, compared with 189.1 per 

100,000).

 High Blood Pressure: African Americans in West Virginia 

are more likely to report having high blood pressure than 

their white counterparts (42.3%, compared with 33.1%). 

 Cardiovascular Disease: From 1996 to 2000, in West 

Virginia the death rates among African Americans for heart 

disease (669 per 100,000) and stroke (137 per 100,000) 

were higher than the corresponding rates for whites (642 per 

100,000 for heart disease and 117 per 100,000 for stroke).

Opportunities for Success
Profiling the Leading Causes of Death in the United States

Heart Disease, Stroke, and Cancer 

Wyoming

250

200

150

100

50

0

300

Heart Disease Stroke All Cancers 

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

United States Wyoming

Chronic Diseases: The Leading Causes of Death

The Leading Causes of Death

United States and Wyoming, 1995 and 2001

1995 2001 1995 2001 1995 2001

The Burden of Chronic Disease

Chronic diseases—such as heart disease, stroke, cancer, and diabetes—are among the most prevalent, 

costly, and preventable of all health problems. Seven of every ten Americans who die each year, or 

more than 1.7 million people, die of a chronic disease.

Reducing the Burden of Chronic Disease

Chronic diseases are not prevented by vaccines, nor do they just disappear. To a large degree, the 

major chronic disease killers are an extension of what people do, or not do, as they go about the 

business of daily living. Health-damaging behaviors—in particular, tobacco use, lack of physical 

activity, and poor nutrition—are major contributors to heart disease and cancer, our nation’s leading 

killers. However, tests are currently available that can detect breast cancer, colon cancer, heart 

disease, and other chronic diseases early, when they can be most effectively treated. (rates per 100,000) 

Source: National Center for Health Statistics, 2003
2

Profiling the Leading Causes of Death in the United States Wyoming

Estimated Cancer Deaths, 2004 

Cause of death US WY

All Cancers 563,700 1,000

Breast (female) 40,110 +

Colorectal 56,730 110

Lung and Bronchus 160,440 260

Prostate 29,900 80

Current smoker

Diabetes 

(self-reported)

No leisure time

physical activity

0 20% 40% 60% 80% 100%

US WY

Overweight

(adult self-reported)

Not eating five 

servings of fruits and

vegetables per day

(adult self-reported)

The Leading Causes of Death and Their Risk Factors

Did not have a 

mammogram in the 

last 2 years (age 50+)

Did not have a 

Pap smear

in the last 3 years

Did not have a 

sigmoidoscopy/colonoscopy

in the last 5 years (age 50+)

Did not have a fecal

occult blood test (FOBT) in 

the last year (age 50+)

US WY

+ Represents fewer than 50 deaths.

Preventive Screening Trends, 2002

Source: BRFSS, 2004 Source: BRFSS, 2003

0 20% 40% 60% 80% 100%

Had a prostate–specific 

antigen (PSA) test in 

the last year (age 50+) 

Had a digital rectal exam

in the last year (age 50+)

Ever been told 

had high 

blood pressure 

Ever been told had

high cholesterol

Cancer

Cancer is the second leading cause of death and is responsible 

for one of every four deaths in the United States. In 2004, over 

560,000 Americans—or more than 1,500 people a day—will 

die of cancer. Of these annual cancer deaths, 1,000 are expected 

in Wyoming. About 1.4 million new cases of cancer will be 

diagnosed nationally in 2004 alone. This figure includes 2,430 

new cases that are likely to be diagnosed in Wyoming. 

Prevention Opportunities 

The number of new cancer cases can be reduced and many 

cancer deaths can be prevented. Adopting healthier lifestyles—

for example, avoiding tobacco use, increasing physical activity, 

achieving a healthy weight, improving nutrition, and avoiding 

sun overexposure—can significantly reduce a person’s risk 

for cancer. Making cancer screening, information, and referral 

services available and accessible is essential for reducing the 

high rates of cancer and cancer deaths. Screening tests for 

breast, cervical, and colorectal cancers reduce the number of 

deaths by detecting them early. 

Source: American Cancer Society, 2004

Heart Disease and Stroke

Heart disease and stroke are the first and third leading causes 

of death for both men and women in the United States. Heart 

disease is the leading cause of death in Wyoming, accounting 

for 985 deaths or approximately 24% of the state’s deaths in 

2001 (the most recent year for which data are available). Stroke 

is the fifth leading cause of death, accounting for 260 deaths or 

approximately 7% of the state’s deaths in 2001. 

Prevention Opportunities

Two major independent risk factors for heart disease and stroke 

are high blood pressure and high blood cholesterol. Other 

important risk factors include diabetes, tobacco use, physical 

inactivity, poor nutrition, and being overweight or obese. 

A key strategy for addressing these risk factors is to educate 

the public and health care practitioners about the importance of 

prevention. All people should also partner with their health care 

providers to have their risk factor status assessed, monitored, 

and managed in accordance with national guidelines. People 

should also be educated about the signs and symptoms of heart 

attack and stroke and the importance of calling 911 quickly. 

Forty-seven percent of heart attack victims and about the same 

percentage of stroke victims die before emergency medical 

personnel arrive. 

Risk Factors for Heart Disease and Stroke, 2003
3

Profiling the Leading Causes of Death in the United States Wyoming

SURVEILLANCE

Behavioral Risk Factor Surveillance System (BRFSS)

 Wyoming BRFSS

 $165,702 

National Program of Cancer Registries 

 Wyoming Cancer Surveillance Program

$417,474

CHRONIC DISEASE PREVENTION AND CONTROL

Cardiovascular Health Program $0

Diabetes Control Program 

 Wyoming Diabetes Prevention and Control Program

 $275,000 

National Breast and Cervical Cancer Early Detection Program

 Wyoming Department of Health, Breast and Cervical Cancer Early Detection Program

$719,091 

National Comprehensive Cancer Control Program $0 

WISEWOMAN $0

MODIFYING RISK FACTORS

National Tobacco Prevention and Control Program 

 Wyoming Tobacco Prevention and Control Program

$975,274 

State Nutrition and Physical Activity/Obesity Prevention Program $0 

Racial and Ethnic Approaches to Community Health (REACH 2010) $0

Total $2,552,541 

CDC Cancer, Heart Disease, Stroke, and Related Risk Factor Funding for Wyoming, FY 2003 

Wyoming’s Chronic Disease Program Accomplishments

Additional Funding

CDC’s National Center for Chronic Disease Prevention and Health Promotion funds additional 

programs in Wyoming that fall into other health areas. A listing of these programs can be found at 

http://www.cdc.gov/nccdphp/states/index.htm.

The shaded area(s) represents program areas that are not currently funded. The above figures may contain funds that have 

been carried over from a previous fiscal year. 

Examples of Wyoming’s Prevention 

Successes

 Statistically significant decreases in cancer deaths among 

men across all races, with the greatest decrease occurring 

among white, non-Hispanic men (266.7 per 100,000 in 

1990 versus 219.9 per 100,000 in 2000). 

 An 8.9% decrease in the number of women older than age 

50 who reported not having had a mammogram in the last 2 

years (from 35.5% in 1992 to 27.8% in 2002). 

 Lower prevalence rates than the corresponding national 

rates for self-reported high blood pressure (23.8% in 

Wyoming versus 24.8% nationally). 

CDC’s Chronic Disease Prevention and 

Health Promotion Programs

In collaboration with public and private health organizations, 

CDC has established a national framework to help states obtain 

the information, resources, surveillance data, and funding 

needed to implement effective chronic disease prevention 

programs and ensure that all Americans have access to quality 

health care. CDC funding and support enable state health 

departments to respond efficiently to changing health priorities 

and effectively use limited resources to meet a wide range of 

health needs among specific populations. The table below is a 

breakdown of the CDC’s funding awards to Wyoming in the 

areas of cancer, heart disease, stroke, and related risk factors. 
4

Wyoming Profiling the Leading Causes of Death in the United States

Opportunities for Success

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention

SAFER • HEALTHIER • PEOPLE TM

For more information, additional copies of this document, or copies of publications referenced in this document, please contact 

the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Mail Stop K-42,

4770 Buford Highway NE, Atlanta, GA 30341-3717 | Phone: (770) 488-5706 | Fax: (770) 488-5962

E-mail: ccdinfo@cdc.gov | Web: http://www.cdc.gov/nccdphp

Chronic Disease Highlight:

Cardiovascular Disease

Cardiovascular disease (CVD), including coronary heart 

disease and stroke, is the number one cause of death in the 

state of Wyoming, accounting for almost 33% of all deaths 

in 2001. The age-adjusted death rate for heart disease in 

Wyoming decreased from 232.1 per 100,000 in 1999 to 216.9 

per 100,000 in 2000; the state’s age-adjusted death rate for 

stroke also decreased, from 61.5 per 100,000 in 1999 to 58.1 

per 100,000 in 2000. 

However, the major risk factors associated with CVD remain 

prevalent in Wyoming’s population. According to 2003 data 

from the Behavioral Risk Factor Surveillance System, 22.4% 

of Wyoming’s adult population reported that they had been 

diagnosed with high blood pressure, 30.5% reported that they 

had been diagnosed with high blood cholesterol, and 4.5% 

reported that they had been diagnosed with diabetes. Thirty 

seven percent of Wyoming residents are overweight and nearly 

20.1% are obese. Additionally, in 2003, more than one fifth 

of all adults in the state did not engage in any leisure time 

physical activity, and 24.6% were smokers. 

The burden of CVD is not limited to morbidity and mortality. 

Between July 2000 and June 2001, 18,783 people were 

discharged from Wyoming hospitals with either a primary or a 

secondary diagnosis of CVD, resulting in a cost of over $246 

million. While CVD-related diagnoses accounted for only 35% 

of the total number of diagnoses, the cost of CVD and CVDrelated diagnoses accounted for 54% of the total cost of all 

hospital discharges.

In an effort to address the problem of CVD in Wyoming, the 

Cardiovascular Disease Program works to prevent, detect, 

and monitor cardiovascular disease within the state. The CVD 

Program provides cardiovascular disease health promotion and 

disease prevention programs to communities and to health care 

providers. The CVD Program focuses on primary prevention, 

where CVD-related risk factors such as physical activity, 

nutrition, high blood pressure, and high blood cholesterol are 

addressed. The CVD Program also sponsors the Wyoming 5 A 

Day Program, and the Wyoming Walks Program. 

Text adapted from The Burden of Cardiovascular Disease in Wyoming (2003).

Disparities in Health

Across the country, American Indians and Alaska Natives

(AI/ANs) comprise more than 500 federally recognized tribes 

and represent 1% of the U.S. population. Compared with other 

racial and ethnic minorities, AI/ANs have the highest poverty 

rate, 26%, which is 2 times the national rate. In addition to 

high poverty levels, AI/ANs are experiencing growing health 

disparities. 

AI/ANs are the second largest minority population in 

Wyoming, representing approximately 3% of the state’s 

population. Over half of this population lives in Fremont 

County, home of the Wind River Indian Reservation. 

Wyoming’s AI/AN population lives in extreme poverty: 58% 

of the population lives below the poverty level.

Wyoming’s AI/AN populations have high rates of heart 

disease, cancer, liver disease, and diabetes. The state’s 

AI/ANs are more than twice as likely to die from heart disease 

(179.1 per 100,000) than the nation’s AI/AN population 

(76 per 100,000). Wyoming’s AI/AN population has much 

higher death rates for diabetes (47.8 per 100,000) and liver 

disease (57.8 per 100,000) than the national rates for AI/ANs 

(27.3 per 100,000 for diabetes and 24.3 per 100,000 for liver 

disease). Likewise, Wyoming’s AI/AN populations are more 

likely to die from cancer than AI/ANs nationally (113.4 deaths 

per 100,000 versus 80.8 deaths per 100,000).

In September 2000, the Minority Health Program in the 

Wyoming Department of Health received funding to conduct 

a statewide minority health assessment. The findings of the 

assessment will help the state to better clarify the areas of 

greatest need among racial and ethnic populations.

Other Disparities

 Overweight: In Wyoming, AI/ANs are more likely to be 

overweight than whites (41% versus 29%). 

 Smoking: Wyoming’s AI/ANs are more likely to smoke 

than whites (39% versus 24%). 

 Mammograms: AI/AN women in Wyoming are more 

likely to have had a mammogram in the past 2 years than 

their white counterparts (74.8% versus 65.6%).

 High blood pressure: AI/ANs have lower rates of high 

blood pressure than whites (18% versus 23%).