 Patient being prepared for surgery at Carolinas Medical Center (Wade Bruton) |
Total MortalityHeart DiseaseCerebrovascular DiseaseCancer |
The official count for deaths in the United States in 2000 was 2,403,351, and the age-adjusted death rate (elimination of effects of aging) was 873 per 100,000. The comparable rate for North Carolina was 964 per 100,000, somewhat higher than the nation. The overall life expectancy for North Carolinians in 2000 was 75.6 years, or about a year less than the national average. As many North Carolina health and distribution maps demonstrate, patterns of regional variation continue to reflect culture, history, economic development difference and social disparities. The average mortality rate by counties for the years 1999-2001 is indeed a reflection of these divisions (Figure 1). Most of North Carolina’s affluent counties, extending from Charlotte to Greensboro and the Research Triangle, North Carolina’s historic “Piedmont Crescent” and many surrounding areas, enjoy some of the lowest overall mortality rates in the state. The same is true for counties such as Watauga and Pitt, with youthful university-base populations and Cumberland and Onslow with large military installations. In opposition, some of the highest death rates are found in poorer Mountain and Coastal counties. Indeed, when compared with overall percentages of the population below the poverty level (Figure 2), these regional contrasts are quite striking. Clearly, differences in mortality due to various causes demonstrate more complex patterns and explanations than overall deaths.
Heart Disease is by far the leading single cause of death in North Carolina. About thirty percent of all deaths were due to some form of heart disease. While substantial, this proportion is actually on the decline. Indeed, for much of the twentieth century, such deaths were on the increase, but by the mid-1980s, however, heart disease rates had begun to fall nationally and in North Carolina. This decline continued into the current century among both males and females of all races. A combination of factors, including changing life styles, early detection and prevention, and improved medical care, all seem to have contributed to this shift.
An historical perspective helps in understanding the geography
of heart disease in North Carolina. During the last several decades of the
twentieth century,
for example, pockets of counties in the western Mountains, one area in the
southern Piedmont and a concentration of counties in the northeastern part
of the state
reported the highest heart disease mortality rates. Conversely, some of the
lowest rates were reported for many of the more urbanized counties. By the
mid-1990s
the heart disease mortality rate for North Carolina, at 275 per 100,000, had
dropped to below the U.S. rate of 288 per 100,000, and the three-year average
for the 1999-2001 period was 237.6 per 100,000, compared to 258 per 100,000
in the US for 2000. As depicted within Figure 3, there continued to be a clustering
of somewhat higher than average heart disease rates in counties in the northeastern
part of the state as well as in the western Mountains, while the urbanized
Piedmont
has continued to have lower than average rates. Sets of counties caught in
the economic shadow of nearby urban growth nodes such as Charlotte, Fayetteville,
and Jacksonville. In addition, two counties with proportionately higher university-related
populations, Watauga and Pitt, reported lower than average rates for the 1999-2001
periods.
Cerebrovascular disease, or stroke, can be manifested by the abrupt onset of multiple conditions. A stroke results from a disturbed blood supply that leads to an inadequate flow to the brain. Loss of speech and/or the use of all or part of the arms and legs often takes place. A mild stroke may result only in short term disability, but a severe stroke can lead to permanent disability or even death. A stroke can begin with the loss of consciousness but sometimes early symptoms only include blurred vision and dizziness. Strokes often happen between midnight and 6:00 A.M. Frequently, either the right or left side of the body is affected, depending upon which half of the brain suffers damage.
As with heart disease, deaths due to stroke have declined over
the past several decades. Nonetheless, stroke deaths in North Carolina continue
to be well above
the national average. Also, the Centers for Disease Control reported in 2003
that North Carolina has the fourth highest stroke rate in the country for persons
over 35 years of age. The U.S. stroke mortality rate for 2001 was about 61
per 100,000 but the North Carolina rate was about 72 per 100,000. The heaviest
geographical
concentrations of stroke mortality in the United States have traditionally
been in the Southeast. Closely following a long-known “stroke belt” pattern,
coastal North Carolina stroke mortality rates are quite similar to those for
South Carolina and Georgia. As the average annual distributions for the 1999-2001
period show (Figure 4), decades-old geographical variations in the incidence
of cerebrovascular disease mortality within the state continue as a microcosm
of some known national distributions. In addition to heavy concentrations of
stroke mortality in the Coastal Plain, some of the more urbanized Piedmont
counties continue to report moderate to average rates.
As a general disease, cancer is second to only heart disease as a leading cause of death in both North Carolina and the nation. Just as heart disease mortality has decreased as a proportion of deaths nationally, cancer rates and proportions have increased, from a national share of about 16 percent in the mid-1990s to nearly 23 percent in 2000. In 2001, the mortality proportion was the same for North Carolina (23 percent). The mortality rate of 207 per 100,000 in North Carolina was somewhat higher than the national rate of 201 per 100,000 in 2001. Just as there are many forms of heart disease, there are also different kinds of cancer.
Cancers have been generally defined as uncontrolled new growths which invade and destroy living tissue. These growths are made up of cancerous cells different from normal cells in size, shape, growth rates and many other ways. Malignant tumors are, of course, different from benign types, and are characterized by growth beyond the body organ of origin. Unlike heart disease, which is on the decline, cancer as a leading cause of death is on the increase, and this aspect of disease geography is quite pronounced when examining distributions within North Carolina.
Given the availability of improved screening procedures and the initiation of more timely treatment, many forms of cancer are being contained for longer periods of time. Cancer geography is therefore more clearly understood by examining the incidence, or new cases, of cancer in conjunction with mortality, or deaths from cancer. Figure 5 contains the distribution of new cases per year averaged for the time period 1996-2000. The distribution of new cases of cancer does not correspond with many of the patterns of mortality for leading causes of death. Instead, many of the state’s more populous counties have been demonstrating a higher incidence. Conversely, some of the counties with lower incidence actually have much smaller populations. A different cancer geography pattern surfaces when mortality is examined. Cancer deaths per 100,000 persons averaged for the 1991-2001 time frame are depicted within Figure 6. As with many other health problems, there are heavier concentrations of high mortality in the eastern part of the state. Many issues are involved with this apparent disparity in cancer patterns. In spite of increasing cancer incidence in recent years, mortality is on the decline. Early detection and improved treatment programs have resulted in a situation wherein sustained access to treatment continues to be a major issue in cancer control.
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