Weekly EBM Update 11.16.18

Welcome to the EBM Weekly Update!

This week we chose one article highlighting an important shift in the epidemiology of mortality in the United States (attached above). The second is an opinion piece that finds itself where medicine, politics, policy abut. It is a response to the recent comments of the NRA directed at the medical community, written by Dr. Ester Choo here at OHSU.


Socioeconomic Differences in the Epidemiologic Transition From Heart Disease to Cancer as the Leading Cause of Death in the United States, 2003 to 2015: An Observational Study (Annals of Internal Medicine 11/2018)

Cardiovascular disease has long been known as the number one cause of mortality amongst women and men in the United States, with cancer coming in a close second. However, epidemiological data demonstrates a change in this pattern. Improved preventative cardiology with better control of risk factors such as smoking, hypertension, hyperlipidemia, and cholesterol in addition to improved management of acute coronary syndromes has greatly impacted mortality due to cardiovascular disease. While the CDC still lists cardiovascular disease as the leading cause of death based on 2015 data, due to the improvements listed above it is estimated that cancer will be the leading cause of death in the United States by 2020. The authors of this study evaluated socioeconomic and racial/ethnic factors influencing this epidemiological change.  The results indicated that cancer became the leading cause of death in 2015 amongst Asian Americans, Hispanics, and Non-Hispanic whites, in contrast to 2003, when heart disease was the leading cause of death. This shift was not evident for American Indians/Alaska Natives or blacks. Amongst the lowest-income counties, heart disease was the leading cause of death in 2015 across all racial groups. In the highest-income counties, Cancer was the leading cause of death amongst Hispanics, Asian Americans, and Non-Hispanic whites. Mortality was decreased for all racial groups except American Indians/Alaska Natives. Mortality rates decreased most across all racial groups in the highest income quintile. Blacks in the highest-income counties had cardiovascular mortality rates similar to Non-Hispanic whites in the lowest- income counties. 

Take home: An epidemiological shift appears to be occurring with cancer becoming the predominant cause of mortality amongst the United States population compared to heart disease. However, significant racial/ethnic and socioeconomic disparities remain, particularly in blacks, who had higher overall mortality than any other group, and American Indians/Alaska Natives- the one group with increased all-cause mortality over the study period, highlighting the need for improved advocacy, healthcare, and resource allocation for these populations. 

Link to article


Dr. Esther Choo: The NRA denies the reality of gun violence. Doctors like me know it all too well. ( NBC News 11/2018)

The second piece this week is not an original research piece, but rather is an article recently written by OHSU’s Dr. Esther Choo regarding the ongoing mass-shooting crisis. This is an excellent opinion piece highlighting recent events and the role and duty that we have as physicians in striving to provide a healthy, safe, and inclusive environment to all those around us. I encourage all to take a moment to read this well written- and well thought- article. 

Link to article