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© Trauer, Freak-Poli, Kippen and McNeil 2018. Published under the Creative Commons Attribution-NonCommercial licence 
3.0 Australia (CC BY-NC 3.0 AU). Journal website: www.australianpopulationstudies.org 

 

Fifty years of plummeting 
cardiovascular death rates and 
implications for the individual 

James M Trauer*  Monash University 

Rosanne Freak-Poli  Monash University 

Rebecca Kippen  Monash University 

John McNeil  Monash University 

* Corresponding author. Email: james.trauer@monash.edu.au. Address: Epidemiological 

Modelling Unit, School of Public Health and Preventive Medicine, Monash University, 553 St 

Kilda Road, Melbourne, Victoria 3004 

Paper received 5 March 2018; accepted 26 March 2018; published 28 May 2018 

Mortality rates have been reliably reported for many decades and provide important insights into 

major changes in disease burden or ‘epidemiological transitions’ (Freak-Poli, Bi and Hiller 2007; 

Omran 1977). Here we present illustrations of the dramatic shift from cardiovascular disease to 

cancer as the leading cause of death in Australia and highlight the significance of these changes for 

individual Australians. 

We obtained data on the total number of deaths and population size for the period 1907–2014 in 

Australia from the General Record of Incidence of Mortality (GRIM) books (Australian Institute of 

Health and Welfare 2017) and used this information to calculate death rates overall and by age group 

attributable to all causes, cardiovascular disease and cancer. The small proportion of deaths 

(generally <0.1%) for which age group was missing were assumed to be distributed as for the deaths 

for which age group was known. These calculated death rates were used to construct life tables, 

under which the complement of the all-cause mortality rate for each year was used to determine the 

number of persons surviving to the following year. As the data are grouped into five-year age groups, 

Karup-King interpolation (Siegel and Swanson 2004) was used to obtain smoothed estimates for each 

year of age in the construction. Full methods are presented as publicly available Python 2.7 code at 

https://github.com/jtrauer/demography. 

We observed dramatic falls in cardiovascular mortality, with cancer overtaking cardiovascular disease 

as the leading cause of death category at the start of this century (Figure 1, left panels). The fall is 

even more impressive when presented on a log-scale, because the steady absolute decrease 

represents a greater proportional decrease as rates decline. Cardiovascular death rates are steadily 

falling across all age groups, although the youngest age brackets have the greatest variation due to 

the noise associated with these very low rates (Figures 1, right panels). While the initial reduction in 

cardiovascular mortality was attributable to reductions in death rates in young adults and middle 

age, increasingly the falls in death rates are occurring in older age groups. Although the fall appears 

less impressive in the oldest age bracket (85 years and above), this is attributable to the decline in 

death rates being offset by an increase in the age distribution of this age group. 

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http://www.australianpopulationstudies.org/
mailto:james.trauer@monash.edu
https://github.com/jtrauer/demography


Australian Population Studies 2 (1) 2018 Trauer J, Freak-Poli R, Kippen R and McNeil J 53 

 

 

Figure 1: Death rates by cause and cardiovascular death rates by age group from 1964–2014 in Australia 

Source: Australian Institute of Health and Welfare (2017). Notes: Left two panels show death rates standardised to the age 
structure of the Australian Bureau of Statistics standard Australian population 2001. Right two panels show age-specific 
death rates attributable to cardiovascular disease.  

These changes have translated into massive changes in survival and cause of death (Figure 2). For 

example, a person subject to the age–cause-specific death rates of 1964 would probably be dead 

before their 80th birthday, with cardiovascular disease the likely cause of death. By contrast, a 

person subject to the age–cause-specific death rates of 2014 would probably live to celebrate their 

85th birthday, and likely die of non-cardiovascular causes before turning 90. Again note that death 

rates for those aged 85 years and above are considered as a single age group, which was used to 

calculate survival from 85–89 years. Therefore, our findings emphasise the need for disaggregation of 

this oldest age group, which has grown from a very small group to a considerable size, and continues 

to grow. 

Past modelling in similar developed country settings suggests that the dramatic reductions in 

cardiovascular mortality are attributable both to changes in the population prevalence of 

predisposing risk factors and medical treatments – the latter including both clinical care for episodes 

of disease and secondary prevention (Capewell et al. 2000; Capewell, Morrison and McMurray 1999). 

Pharmacological primary prevention has not contributed significantly to these major reductions in 

the past, although results from large community-based randomised controlled trials into aspirin 

(ASPREE Investigator Group 2013) and statins (Zoungas et al. 2014) as primary preventive 

interventions will shed light on this potent. However, while intervention studies can quantify the 



54 Trauer J M, Freak-Poli R, Kippen R and McNeil J Australian Population Studies 2 (1) 2018 

 

relative reduction in incident cardiovascular disease, one of the most important issues to address 

before recommending prevention strategies to individuals is the absolute risk of new cardiovascular 

disease (Otto 2016). While disease-specific mortality rates do not translate directly to rates of 

incident disease, the dramatic reductions in cardiovascular death rates over recent decades are likely 

to reflect decreases in cardiovascular disease to some extent. Therefore, it is essential to ensure 

guidelines are based on risk assessments that consider modern rates of incident cardiovascular 

disease by demographic and comorbidity status. 

Cancer mortality is presented for comparison as it is the other major disease category responsible for 

a high proportion of deaths over recent decades. Although cancer mortality appears relatively stable 

over this period, the aggregate rates mask important underlying trends in cancer types by gender 

(Freak-Poli, Bi and Hiller 2007 With non-cardiovascular mortality remaining relatively stable, it is clear 

that the declines in overall mortality directly parallel those in cardiovascular-specific mortality (Figure 

1, upper left panel). This highlights how critical these improvements have been in driving Australia’s 

recent improvements in overall life expectancy, to the extent that falling cardiovascular mortality has 

entirely driven the all-cause mortality decreases. 

 

Figure 2: Cumulative outcomes for an Australian living their life with death rates as observed in 1964, 1989 

and 2014 

Source: Australian Institute of Health and Welfare (2017). Notes: Survival region represents a life-table, with cumulative 
contributions of three cause of death categories presented as shaded regions above. Data from five-year brackets are 
smoothed by calculating yearly estimates using Karup-King interpolation.  



Australian Population Studies 2 (1) 2018 Trauer J, Freak-Poli R, Kippen R and McNeil J 55 

 

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