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The world trends of mortality: Heart disease versus cancer

The Skeptik 2013;3:91-96

Ginter E

Slovak Medical University, emeritus, Bratislava, Slovakia

From 1970 to 2010, the global life expectancy at birth increased in males from 56 years to 68 years and in females from 61 years to 73 years. Decreasing age-specific and cause-specific death rates have combined to drive a broad shift from communicable and nutritional causes towards non-communicable diseases - heart disease and cancer. The claim „heart disease still remains number one killer worldwide“ is perpetraded in numerous popular articles. The recent data and this paper throw skeptic look on this statement.

Key words: life expectancy at birth, global world health, communicable and non-communicable diseases, heart disease and cancer mortality

Recent global mortality trends are described in a very extensive report on global and regional mortality related to 235 causes of death between 1990 and 2010, published in December 2012 (1). The authors attempted to identify all available causes of death for 187 countries from vital registration and autopsy records. For Europe we used reports of the World Health Organization (WHO) (2). To simplify an extensive report (1) on 235 causes of death, Tab. 1 summarizes the most important groups of disease and reflects health trends as an absolute mortality from different causes in the world.

The total global mortality in 2010 reached 52.8 million, 13.5 % more than in 1990. There was a higher number of deaths in people age 70 and older. These numbers have to be interpreted with regard to the absolute growth and aging of the world population. Decline in communicable, neonatal and nutritional disorders from 15.9 millions to 13.2 millions per year is encouraging. Less positive are trends in non-communicable disorders, especially cancer and ischaemic heart disease (IHD). Catastrophic was the rise in mortality related to diabetes type 2, undoubtedly associated with the epidemic of obesity (3). Neurologic and mental disorders also increased.

Most of Europe experienced substantial improvement of general health during the past decades. Life expectancy in most countries prominently improved in 1990 through 2010. Exception, less favorable, is Ukraine, Belarus and the Russian Federation. In Europe we used as mortality indicator premature mortality (mortality in age interval 0-64 years). Premature mortality is a more reliable index of health than the general mortality, it better reflects the overall survival and the causes of death. The diagnosis of terminal disease is more accurate at an earlier age and it is more often supported by refined diagnostic techniques and autopsy than in the very old where diagnostic criteria are less strongly enforced. In the well-established democratic part of Europe there has been a steady decline in premature IHD mortality – Fig. 1. In contrast, the trends of cancer mortality has been less prominent (decrease, increase, no change) – Fig. 2.

Fig. 1. Significant decline of male premature (age interval 0-64 years) ischaemic heart disease mortality in democratic Europe.

Fig. 2. Different trends of male premature cancer mortality in Europe.

In several countries cancer mortality has become the most pressing health problem. A good example is Spain where the male premature mortality for cancer is twice that of cardiovascular (CVD) mortality – Fig.3. In France male mortality for cancer is six times higher that of IHD (!).

Fig. 3. Evident increase of the ratio cancer/cardiovascular premature male mortality in Spain.

Such trends, cancer mortality overcoming IHD mortality, are even more pronounced in women. In democratic countries in Europe, the premature female cancer mortality in 2009 was 56/100 000 while mortality for IHD was only 5/100 000 (!). In European Union more than 1/3 of premature deaths is caused by cancer – Fig. 4.

Fig. 4. Structure of premature mortality in European Union in 2012.

These mortality trends provide a reminder for health care planners to primarily focus on prevention and management of malignant disorders.

CAUSE OF DEATH 1990 2010 Difference
Cancer (total) 5779 7978 + 38,0 %
Ischaemic heart disease 5312 7029 + 34,9 %
Cerebrovascular disease 4660 5874 + 26,0 %
Injuries 4092 5073 + 24,0 %
Chronic respiratory diseases 3986 3776 - 5,3 %
Neonatal disorders 3081 2236 - 27,4 %
Self-harm and violence 1009 1340 + 32,9 %
Diabetes mellitus 685 1281 + 92,7 %
Neurological disorders 595 1274 + 114,3 %
Mental and behavioural disorders 138 232 + 68,0 %


1. GBD. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;.380 : 2095–2128.

2. WHO. European health for all database, WHO Regional Office for Europe 2012.

3. Ginter E, Simko V. Diabetes type 2 pandemic in 21st century. Bratisl Lek Listy 2010;111:134-137.