U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS Data Brief ■ No. 254 ■ August 2016

Changes in the Leading Cause of Death: Recent Patterns in 

Heart Disease and Cancer Mortality

Melonie Heron, Ph.D. and Robert N. Anderson, Ph.D.

Key findings 

Data from the National 

Vital Statistics System

● Heart disease has 

consistently been the leading 

cause of death in the United 

States and remained so in 2014. 

● The gap between the number 

of heart disease and cancer 

deaths generally widened from 

1950 through 1968, narrowed 

from 1968 through 2012, and 

then slightly widened again 

from 2012 through 2014. 

● The mortality burden of 

cancer has surpassed that of 

heart disease in several states. 

In 2000, there were only 2 

states where cancer was the 

leading cause of death; in 2014, 

there were 22.

● Heart disease remained 

the leading cause of death for 

the non-Hispanic white and 

non-Hispanic black populations 

in 2014. 

● Cancer is now the leading 

cause of death for the nonHispanic Asian or Pacific 

Islander and Hispanic 

populations. The timing of the 

leading-cause crossover varied 

by group.

For the total U.S. population, heart disease has been the leading cause of death 

for decades, with cancer the second leading cause (1). However, the ranking 

of these causes has varied across demographic group and geographic unit over 

time. Rankings are based on the number of deaths and reflect mortality burden 

rather than risk of death (2). This report highlights changes in the mortality 

burden of heart disease and cancer and presents findings by state, race, and 

Hispanic origin. 

Keywords: state • race • ethnicity • National Vital Statistics System

How has the mortality burden of heart disease and cancer 

changed from 1950 through 2014?

● The number of deaths due to heart disease has consistently been higher 

than the number of deaths due to cancer (Figure 1). 

Figure 1. Number of deaths due to heart disease and cancer: United States, 1950–2014 Number of deaths

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Cancer

Heart disease

2014

1980 1990 2000 2010

Year

1950 1960 1970

NOTES: Leading cause is based on number of deaths. Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/

db254_table.pdf#1.

SOURCE: NCHS, National Vital Statistics System, Mortality.
NCHS Data Brief ■ No. 254 ■ August 2016

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● The number of heart disease deaths decreased from a peak of 771,169 in 1985 to 596,577 in 

2011, whereas the number of cancer deaths nearly tripled from 210,733 in 1950 to 576,691 

in 2011. 

● The number of deaths due to heart disease increased by 3.0% during the 2011–2014 period, 

from 596,577 to 614,348. Cancer deaths increased by 2.6% during the same period, from 

576,691 to 591,699. 

● The closing gap between heart disease and cancer suggested that a leading-cause crossover 

was likely in the early 2010s, but the reversal in trend for heart disease deaths in 2012 has 

kept heart disease just ahead of cancer in the rankings.

Are there differences by state in the leading cause of death, and how have 

patterns changed from 2000 through 2014? 

● Heart disease was the leading cause of death for all of the United States until 1990, when 

cancer became the leading cause of death for Alaska (data not shown). 

● As of 2000, Alaska and Minnesota were the only two states where cancer was the leading 

cause of death (Figure 2).

● From 2000 through 2014, the cancer mortality burden surpassed that of heart disease in 

several other states. As of 2014, cancer was the leading cause of death in 22 states.

 

Figure 2. Leading cause of death for each state: United States, 2000 and 2014

NOTE: Leading cause is based on number of deaths.

SOURCE: NCHS, National Vital Statistics System, Mortality.
NCHS Data Brief ■ No. 254 ■ August 2016

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How has the mortality burden of heart disease and cancer changed for the 

non-Hispanic white population from 2000 through 2014? 

● For the non-Hispanic white population, heart disease has been and remains the leading cause 

of death, with cancer the second leading cause (Figure 3). 

● Since 2000, heart disease deaths generally decreased while cancer deaths increased. 

However, in recent years, the trend in heart disease deaths has reversed, with deaths 

increasing by 1.6% from 2012 through 2014. 

● The gap between heart disease and cancer deaths for the non-Hispanic white population 

decreased substantially, from 136,265 in 2000 to a low of 19,492 in 2012, but it increased in 

subsequent years.

Figure 3. Number of deaths due to heart disease and cancer for the non-Hispanic white population: United States, 

2000–2014 

NOTES: Leading cause is based on number of deaths. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db254_table.pdf#3.

SOURCE: NCHS, National Vital Statistics System, Mortality.
NCHS Data Brief ■ No. 254 ■ August 2016

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How has the mortality burden of heart disease and cancer changed for the 

non-Hispanic black population from 2000 through 2014?

● For the non-Hispanic black population, heart disease and cancer have consistently been the 

first and second leading causes of death, respectively (Figure 4). 

● The decreasing trend in heart disease deaths since 2000 reversed, with deaths increasing by 

6.4% during 2011–2014.

● The gap between heart disease and cancer deaths for the non-Hispanic black population 

narrowed from 15,316 in 2000 to a low of 1,437 in 2011. During 2012–2014, the gap was 

two to three times larger than in 2011.

Figure 4. Number of deaths due to heart disease and cancer for the non-Hispanic black population: United States, 

2000–2014 

NOTES: Leading cause is based on number of deaths. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db254_table.pdf#4.

SOURCE: NCHS, National Vital Statistics System, Mortality.
NCHS Data Brief ■ No. 254 ■ August 2016

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How has the mortality burden of heart disease and cancer changed for the 

non-Hispanic Asian or Pacific Islander (API) and Hispanic populations from 

2000 through 2014?

● For the non-Hispanic API population, cancer became the leading cause of death in 2000 

when the number of cancer deaths (9,069) surpassed heart disease deaths (8,949) (Figure 5). 

● During 2000–2014, the number of cancer deaths for the non-Hispanic API population 

increased by 79.6% (from 9,069 to 16,292) compared with a 45.5% increase in heart disease 

deaths (from 8,949 to 13,021). 

● For the Hispanic population, the number of cancer deaths increased by 72.2% during 

2000–2014 (from 21,160 to 36,447), while the number of heart disease deaths increased by 

31.8% (from 25,819 to 34,021). 

● Cancer replaced heart disease as the leading cause of death for the Hispanic population in 

2009, when the number of cancer deaths (29,935) surpassed heart disease deaths (29,611).

Figure 5. Number of deaths due to heart disease and cancer for the non-Hispanic Asian or Pacific Islander and Hispanic 

populations: United States, 2000–2014 

NOTES: API is Asian or Pacific Islander. Deaths for the non-Hispanic API and Hispanic populations are underreported by 3% each; see “Data source and 

methods.” Leading cause is based on number of deaths. Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db254_table.pdf#5.

SOURCE: NCHS, National Vital Statistics System, Mortality.
NCHS Data Brief ■ No. 254 ■ August 2016

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Summary

This report presents recent changes in the mortality burden of heart disease and cancer. Since the 

early 1900s, heart disease has been the leading cause of death in the United States and cancer 

the second leading cause (1). The number of deaths due to both heart disease and cancer has 

increased since 1950, largely due to the aging of the U.S. population. However, in the 1980s, 

the number of deaths due to heart disease began to decline, whereas the number of deaths due to 

cancer continued to increase. The result has been a substantial decrease in the gap between the 

two causes. While a leading-cause crossover seemed likely in the early 2010s, a reversal in the 

trend in heart disease deaths in 2012 kept heart disease in the top spot in the rankings. 

Although a change in the rankings has not occurred for the United States as a whole, the rankings 

have changed for many states. By 2014, cancer had replaced heart disease as the leading cause of 

death in 22 states. While the gap in mortality burden between heart disease and cancer narrowed 

substantially for the non-Hispanic white and black populations, heart disease remains the leading 

cause for these groups. However, cancer has replaced heart disease as the leading cause of death 

for the non-Hispanic API and Hispanic populations. The timing of the leading-cause crossover 

varied by population subgroup. 

Data source and methods

Mortality data for 1950–2014 presented in this report are from the National Vital Statistics 

System (NVSS) (3). Data are examined by state, race, and Hispanic origin for only the 2000–

2014 period. NVSS mortality data reflect information collected from all death certificates filed 

in the 50 states and the District of Columbia. Deaths are classified according to the International 

Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD–10) 

(4). Heart disease deaths are classified to ICD–10 codes I00–I09, I11, I13, and I20–I51. 

Cancer deaths are classified to ICD–10 codes C00–C97. All mortality statistics are based on 

the underlying cause of death and are restricted to U.S. residents. Race and Hispanic origin 

are reported separately on the death certificate. Persons of Hispanic origin may be of any race. 

Recent research has shown that, in the 1999–2011 period, deaths for the non-Hispanic API and 

Hispanic populations were underreported by 3% for each group, whereas no underreporting 

(or overreporting) of deaths was observed for the non-Hispanic white and non-Hispanic black 

populations (5). It was assumed that the levels of racial and ethnic underreporting observed in 

1999–2011 data also apply to 2012–2014 data. Racial and ethnic underreporting is not expected 

to vary by cause of death or greatly impact leading-cause rankings (2). 

Cause-of-death rankings indicate the mortality burden of one cause relative to other rankable 

causes. Mortality burden is measured based on the number of deaths (2). It does not indicate 

cause-specific mortality risk as death rates do.

Specified changes in the number of deaths are statistically significant at p < 0.05. Tests of 

statistical significance are described elsewhere (6).

About the authors

Melonie Heron and Robert N. Anderson are with the National Center for Health Statistics, 

Division of Vital Statistics.
NCHS Data Brief ■ No. 254 ■ August 2016

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References

1. National Center for Health Statistics. Leading causes of death, 1900–1998. 2000. Available 

from: http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf.

2. Heron M. Deaths: Leading causes for 2014. National vital statistics reports; vol 65 no 5. 

Hyattsville, MD: National Center for Health Statistics. 2016. Available from: http://www.cdc.gov/

nchs/data/nvsr/nvsr65/nvsr65_05.pdf.

3. National Center for Health Statistics. National Vital Statistics System. Mortality multiple 

cause files. Available from: http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm.

4. WHO. International statistical classification of diseases and related health problems, tenth 

revision (ICD–10). 2008 ed. Geneva, Switzerland. 2009.

5. Arias E, Heron M, Hakes JK. The validity of race and Hispanic-origin reporting on death 

certificates in the United States: An update. Vital Health Stat 2(172). Hyattsville, MD: National 

Center for Health Statistics. 2016. Available from: http://www.cdc.gov/nchs/data/series/sr_02/

sr02_172.pdf.

6. Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National 

vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016. 

Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf.
NCHS Data Brief ■ No. 254 ■ August 2016

Suggested citation

Heron M, Anderson RN. Changes in the 

leading cause of death: Recent patterns in 

heart disease and cancer mortality. NCHS 

data brief, no 254. Hyattsville, MD: National 

Center for Health Statistics. 2016.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

Hanyu Ni, Ph.D., M.P.H., Associate Director 

for Science

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